Individual
AMY BROADWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
236 ELM DR STE 101, WAYNESBURG, PA 15370-8265
(724) 627-0926
(724) 627-0812
Mailing address
236 ELM DR STE 101, WAYNESBURG, PA 15370-8265
(724) 627-0926
(724) 627-0812
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA002774L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100772557-0020
—
PA
Enumeration date
06/28/2006
Last updated
09/20/2024
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