Provider Demographics
NPI:1306884846
Name:AMORDE, CONNIE L (PA-C)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:L
Last Name:AMORDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:AMORDE-MELCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3097 SANDALWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5509
Mailing Address - Country:US
Mailing Address - Phone:925-296-0810
Mailing Address - Fax:
Practice Address - Street 1:3555 CESAR CHAVEZ
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4403
Practice Address - Country:US
Practice Address - Phone:415-641-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA14581Medicaid
P05282Medicare UPIN