Provider Demographics
NPI:1740859636
Name:DILL, AMANDA LYNN (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:DILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4019
Mailing Address - Country:US
Mailing Address - Phone:864-271-1844
Mailing Address - Fax:864-271-2147
Practice Address - Street 1:203 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4019
Practice Address - Country:US
Practice Address - Phone:864-271-1844
Practice Address - Fax:864-271-2147
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25492363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care