Provider Demographics
NPI:1851701593
Name:DU SABLON, AMANDA WINKLER (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:WINKLER
Last Name:DU SABLON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DIANE
Other - Last Name:WINKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3060 HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-2659
Mailing Address - Country:US
Mailing Address - Phone:828-323-2460
Mailing Address - Fax:828-728-6088
Practice Address - Street 1:3060 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-2659
Practice Address - Country:US
Practice Address - Phone:828-323-2460
Practice Address - Fax:828-728-6088
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-03
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2017-00212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1851701593Medicaid