Doctor Name: | MRS. AMANDA SUE LOIS |
NPI Number: | 1083926802 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 018516 |
Business Practice Address: | 153 W Genesee St Chittenango, NY - 130371528 |
Business Phone Number: | 3156875100 |
Business Fax Number: | 3156870252 |
Mailing Address: | 153 W Genesee St, CHITTENANGO |
State: | NY |
Postal Code: | 130371528 |
Phone Number: | 3156875100 |
Fax Number: | 3156870252 |
NPI Enumeration Date: | 07/09/2010 |
NPI Last Update Date: | 09/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 018516 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |