Provider Demographics
NPI:1861072282
Name:SOWA, AMANDA LOUISE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOUISE
Last Name:SOWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 ATHENA DR
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1201
Mailing Address - Country:US
Mailing Address - Phone:172-467-2134
Mailing Address - Fax:
Practice Address - Street 1:125 LOGANS FERRY RD STE 2
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-2048
Practice Address - Country:US
Practice Address - Phone:866-419-1693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN556493163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health