Provider Demographics
NPI:1760045876
Name:BIERMANN, AMANDA ELLIS
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ELLIS
Last Name:BIERMANN
Suffix:
Gender:F
Credentials:
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 840
Mailing Address - Street 2:
Mailing Address - City:PINETOPS
Mailing Address - State:NC
Mailing Address - Zip Code:27864-0840
Mailing Address - Country:US
Mailing Address - Phone:528-137-1172
Mailing Address - Fax:
Practice Address - Street 1:1800 HERRING AVE E
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-6727
Practice Address - Country:US
Practice Address - Phone:252-399-2246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily