Provider Demographics
NPI:1093216566
Name:RAPAPORT, AMANDA (FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:RAPAPORT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 REITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9208
Mailing Address - Country:US
Mailing Address - Phone:570-214-3052
Mailing Address - Fax:
Practice Address - Street 1:250 REITZ BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9208
Practice Address - Country:US
Practice Address - Phone:570-214-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018543363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner