Provider Demographics
NPI:1386901973
Name:PARISH, AMANDA (LAC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PARISH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 MAYO DR APT 317
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4503
Mailing Address - Country:US
Mailing Address - Phone:608-347-3739
Mailing Address - Fax:608-754-1437
Practice Address - Street 1:5973 EXECUTIVE DR UNIT 1
Practice Address - Street 2:POKE ACUPUNCTURE C/O PINNACLE HEALTH & FITNESS
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5336
Practice Address - Country:US
Practice Address - Phone:608-278-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI750-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist