Provider Demographics
NPI:1710029699
Name:CRAFT, AMANDA B (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:B
Last Name:CRAFT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 KING ST
Mailing Address - Street 2:
Mailing Address - City:LAURELDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19605-2009
Mailing Address - Country:US
Mailing Address - Phone:610-921-2243
Mailing Address - Fax:
Practice Address - Street 1:2111 KING ST
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19605-2009
Practice Address - Country:US
Practice Address - Phone:610-921-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN539464163W00000X
NY535398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse