Provider Demographics
NPI:1346709318
Name:SESSIONS, AMANDA G (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:SESSIONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:GRACE
Other - Last Name:RENNECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1855 N STAPLEY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-3002
Mailing Address - Country:US
Mailing Address - Phone:480-834-7546
Mailing Address - Fax:
Practice Address - Street 1:1855 N STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-3002
Practice Address - Country:US
Practice Address - Phone:480-834-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75501207Q00000X
390200000X
AZ010287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100174760Medicaid