Provider Demographics
NPI:1962978254
Name:GILLIO, AMANDA LYNN (CRNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:GILLIO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 EAGLEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1157
Mailing Address - Country:US
Mailing Address - Phone:610-561-6400
Mailing Address - Fax:484-713-5255
Practice Address - Street 1:278 EAGLEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1157
Practice Address - Country:US
Practice Address - Phone:610-561-6320
Practice Address - Fax:610-561-6301
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103575918-0004Medicaid