Provider Demographics
NPI:1407189210
Name:KOCH, AMANDA RENEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RENEE
Last Name:KOCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:RENEE
Other - Last Name:MEITZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1416 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2134
Mailing Address - Country:US
Mailing Address - Phone:610-376-3936
Mailing Address - Fax:610-372-0215
Practice Address - Street 1:1416 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2134
Practice Address - Country:US
Practice Address - Phone:610-376-3936
Practice Address - Fax:610-372-0215
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant