Provider Demographics
NPI:1265405591
Name:OGRADY, AMY E (CRNP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:OGRADY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 ARRANDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:610-363-0100
Mailing Address - Fax:610-363-3923
Practice Address - Street 1:103 ARRANDALE BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-363-0100
Practice Address - Fax:610-363-3923
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008516363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088266Medicare ID - Type Unspecified
Q36378Medicare UPIN