| Doctor Name: | AMANDA KATHERINE LOISELLE |
| NPI Number: | 1154657021 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 22576519 |
| Business Practice Address: | 79 Mcgaw Ave Lake Grove, NY - 117552024 |
| Business Phone Number: | 6316560820 |
| Business Fax Number: | |
| Mailing Address: | 79 Mcgaw Ave, LAKE GROVE |
| State: | NY |
| Postal Code: | 117552024 |
| Phone Number: | 6316560820 |
| Fax Number: | |
| NPI Enumeration Date: | 10/27/2009 |
| NPI Last Update Date: | 10/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0200X |
| License Number: | 22576519 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |