Individual
AMANDA NORTHEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2301 ERWIN RD, DURHAM, NC 27710-3618
(919) 684-8111
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-6260
(239) 343-6259
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1245873223
NC
363A00000X
Physician Assistant
PA9112766
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104659800
—
FL
Enumeration date
10/23/2019
Last updated
09/06/2023
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