Provider Demographics
NPI:1659535896
Name:BLOCK, AMANDA CHRISTINE (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-390-1400
Mailing Address - Fax:
Practice Address - Street 1:605 E BOONESLICK RD
Practice Address - Street 2:SUITE B
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2127
Practice Address - Country:US
Practice Address - Phone:636-456-6103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008018536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant