Provider Demographics
NPI:1902598121
Name:PITT-WURSTER, AMANDA NICOLE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:PITT-WURSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9754 STATE HIGHWAY 1056
Mailing Address - Street 2:
Mailing Address - City:MC CARR
Mailing Address - State:KY
Mailing Address - Zip Code:41544-8407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9754 STATE HIGHWAY 1056
Practice Address - Street 2:
Practice Address - City:MC CARR
Practice Address - State:KY
Practice Address - Zip Code:41544-8407
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant