Provider Demographics
NPI:1568039360
Name:PETRUSKEVICIUS, AMANDA (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PETRUSKEVICIUS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-0513
Mailing Address - Country:US
Mailing Address - Phone:484-962-0433
Mailing Address - Fax:
Practice Address - Street 1:800 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1603
Practice Address - Country:US
Practice Address - Phone:610-519-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023747363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care