Provider Demographics
NPI:1669708889
Name:HUITE, AMANDA RAE (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RAE
Last Name:HUITE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:1500 E 2ND ST STE 400
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1198
Practice Address - Country:US
Practice Address - Phone:775-982-2400
Practice Address - Fax:775-982-2410
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2020-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085.003634363A00000X, 363A00000X
CAPA56838363A00000X
NVPA2142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208084OtherMEDICARE GROUP NUMBER
IL214881OtherGROUP PTAN
IL214881OtherGROUP PTAN