Provider Demographics
NPI:1861539611
Name:STINNETTE, AMY M (PA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:M
Last Name:STINNETTE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:5900 LAKE WRIGHT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-1871
Mailing Address - Country:US
Mailing Address - Phone:757-213-5700
Mailing Address - Fax:757-213-5701
Practice Address - Street 1:5838 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2663
Practice Address - Country:US
Practice Address - Phone:757-484-0215
Practice Address - Fax:757-484-6792
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2010-07-19
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Provider Licenses
StateLicense IDTaxonomies
VA0110001902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001902OtherSTATE LICENSE