Provider Demographics
NPI:1700268562
Name:MATTER, AMANDA DIONNE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DIONNE
Last Name:MATTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DIONNE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11 SPRINT DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7789
Mailing Address - Country:US
Mailing Address - Phone:717-960-0052
Mailing Address - Fax:
Practice Address - Street 1:11 SPRINT DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7789
Practice Address - Country:US
Practice Address - Phone:717-960-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003552363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA060453OtherPENNSYLVANIA LICENSING BOARD