| Doctor Name: | AMANDA T HALTIWANGER |
| NPI Number: | 1649432477 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | APRN3585 |
| Business Practice Address: | 600 N Wheeler Ave Prosperity, SC - 291278400 |
| Business Phone Number: | 8033644852 |
| Business Fax Number: | 8033642014 |
| Mailing Address: | Po Box 630, 600 N Wheeler Ave PROSPERITY |
| State: | SC |
| Postal Code: | 291270630 |
| Phone Number: | 8033644852 |
| Fax Number: | 8033642014 |
| NPI Enumeration Date: | 07/02/2008 |
| NPI Last Update Date: | 06/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APRN3585 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |