Provider Demographics
NPI:1922132141
Name:IRONS, AMANDA SUSANNE (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUSANNE
Last Name:IRONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-7760
Mailing Address - Fax:704-316-7761
Practice Address - Street 1:2222 N NEVADA AVE STE 4007
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6863
Practice Address - Country:US
Practice Address - Phone:719-776-8500
Practice Address - Fax:719-776-4593
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005276363A00000X
NC0010-03952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009078U92Medicare ID - Type Unspecified
VAQ56259Medicare UPIN