Provider Demographics
NPI:1245402593
Name:KREUTZBERGER, AMANDA L (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:KREUTZBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:NICKOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8300
Mailing Address - Fax:814-410-8331
Practice Address - Street 1:4186 CORTLAND DR
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:PA
Practice Address - Zip Code:15554-7706
Practice Address - Country:US
Practice Address - Phone:814-839-4108
Practice Address - Fax:814-839-4845
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant