Provider Demographics
NPI:1316900855
Name:SLATER, AMANDA W (FNP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:W
Last Name:SLATER
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:56 US HIGHWAY 321 BYP N
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-7100
Mailing Address - Country:US
Mailing Address - Phone:803-635-6099
Mailing Address - Fax:803-635-6343
Practice Address - Street 1:15 MEDICAL PARK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8003
Practice Address - Country:US
Practice Address - Phone:803-255-3417
Practice Address - Fax:803-255-3451
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC83255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC141Medicaid
83255Medicare UPIN
RH428969Medicare ID - Type Unspecified