Provider Demographics
NPI:1598397267
Name:LOVECCHIO, AMANDA JO (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:LOVECCHIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13384 DRIVER RD
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-8670
Mailing Address - Country:US
Mailing Address - Phone:702-557-3466
Mailing Address - Fax:
Practice Address - Street 1:2511 M AVE STE D
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3897
Practice Address - Country:US
Practice Address - Phone:360-293-0308
Practice Address - Fax:360-299-3153
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61037353363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner