Individual
AMANDA I GANDERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1069 DELAWARE AVE, SUITE 205, MARION, OH 43302-1400
(740) 387-4578
Mailing address
1167 INDEPENDENCE AVE, SUITE 205, MARION, OH 43302-6360
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003772
LICENSE
OH
01
—
50.003772RX
OHIO MEDICAL BOARD
OH
Enumeration date
06/10/2013
Last updated
06/21/2021
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