Provider Demographics
NPI:1154961100
Name:ROBERTS, AMANDA (QOM)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:QOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:TYNER
Mailing Address - State:NC
Mailing Address - Zip Code:27980-9690
Mailing Address - Country:US
Mailing Address - Phone:252-506-2522
Mailing Address - Fax:
Practice Address - Street 1:113 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:TYNER
Practice Address - State:NC
Practice Address - Zip Code:27980-9690
Practice Address - Country:US
Practice Address - Phone:252-506-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other