Provider Demographics
NPI:1972024438
Name:HARDING, AMANDA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HARDING
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2929
Mailing Address - Country:US
Mailing Address - Phone:585-546-2771
Mailing Address - Fax:585-454-7001
Practice Address - Street 1:2697 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1701
Practice Address - Country:US
Practice Address - Phone:716-831-2200
Practice Address - Fax:716-831-8836
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341883-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily