Provider Demographics
NPI:1831658368
Name:MCLAUGHLIN, AMANDA LEE (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 RANDOLPH LN
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2274
Mailing Address - Country:US
Mailing Address - Phone:814-282-1297
Mailing Address - Fax:
Practice Address - Street 1:451 FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:16403-1238
Practice Address - Country:US
Practice Address - Phone:814-398-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP020115OtherCRNP