Provider Demographics
NPI:1902247513
Name:CHIPKO, AMANDA ROSE (RN)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:ROSE
Last Name:CHIPKO
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:1787 SENTRY PKWY W STE 405
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2239
Mailing Address - Country:US
Mailing Address - Phone:877-868-4827
Mailing Address - Fax:
Practice Address - Street 1:1787 SENTRY PKWY W STE 405
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2239
Practice Address - Country:US
Practice Address - Phone:877-868-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP020812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
448167Y5ZMedicare PIN