Provider Demographics
NPI:1770861759
Name:BURNETT, AMANDA (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CHATHAM RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3417
Mailing Address - Country:US
Mailing Address - Phone:828-423-7440
Mailing Address - Fax:
Practice Address - Street 1:22 CHATHAM RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3417
Practice Address - Country:US
Practice Address - Phone:828-423-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC616171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist