Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | BF4323200B29 | VT |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD470840 | PA |
NPI | 1417375981 |
---|---|
Provider Name | Ms. Amanda Holleran |
First Address | Danville, PA 17822-4903 |
Second Address | Wilkes Barre, PA 18702-7906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 22/02/2021 |