Provider Demographics
NPI:1770719171
Name:PARSLEY, AMANDA LEIGH (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEIGH
Last Name:PARSLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040
Mailing Address - Country:US
Mailing Address - Phone:618-219-3318
Mailing Address - Fax:618-452-3329
Practice Address - Street 1:2166 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040
Practice Address - Country:US
Practice Address - Phone:618-219-3318
Practice Address - Fax:618-452-3329
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO39020000X208000000X
IL036131746208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics