Individual
AMANDA L HAWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-3443
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-3443
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11004
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417239070
—
MN
05
—
1417239070
—
WI
05
—
ENROLLED
—
MN
Enumeration date
09/09/2011
Last updated
08/14/2019
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