Provider Demographics
NPI:1831650266
Name:RAUNSWINTER, AMELIA JO (PA-C)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:JO
Last Name:RAUNSWINTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:JO
Other - Last Name:CRUTSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1644 KEPLER BND
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-613-0585
Mailing Address - Fax:
Practice Address - Street 1:1644 KEPLER BND
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-613-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant