Doctor Name: | AMANDA NICOLE PISCO |
NPI Number: | 1659733509 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, FNP-C |
License Number: | 4704254562 |
Business Practice Address: | E6112 E Bluffview Rd Ste 101 Ironwood, MI - 499389367 |
Business Phone Number: | 9069322231 |
Business Fax Number: | 9069322620 |
Mailing Address: | E6112 E Bluffview Rd Ste 101, IRONWOOD |
State: | MI |
Postal Code: | 499389367 |
Phone Number: | 9069322231 |
Fax Number: | 9069322620 |
NPI Enumeration Date: | 03/21/2016 |
NPI Last Update Date: | 03/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704254562 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |