Individual
AMANDA TAKKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1524 MCHENRY AVE STE 135, MODESTO, CA 95350-4569
(209) 575-5801
(209) 575-0115
Mailing address
1524 MCHENRY AVE STE 135, MODESTO, CA 95350-4569
(209) 575-5801
(209) 575-0115
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
13136356-1206
UT
363A00000X
Physician Assistant
Primary
62025
CA
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/02/2022
Last updated
03/19/2025
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