Provider Demographics
NPI:1861158529
Name:LIESNER, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LIESNER
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 1:847 EASTON ROAD
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2909
Mailing Address - Country:US
Mailing Address - Phone:215-345-0105
Mailing Address - Fax:215-345-0562
Practice Address - Street 1:847 EASTON ROAD
Practice Address - Street 2:SUITE 2700
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2909
Practice Address - Country:US
Practice Address - Phone:215-345-0105
Practice Address - Fax:215-345-0562
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner