Basic Information
| Provider Information | |||||||||
| NPI: | 1003396821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROEDER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 HOT METAL ST # 1N359 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152032348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124325869 | ||||||||
| FaxNumber: | 4126474486 | ||||||||
| Practice Location | |||||||||
| Address1: | 291 STATE ROUTE 288 | ||||||||
| Address2: | |||||||||
| City: | ELLWOOD CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161175513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247587372 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN57822 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | SP019368 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | SP019368 | 01 | PA | NURSE PRACTITIONER LICENSE | OTHER |