Individual
AMANDA BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1365 WASHINGTON AVE STE 100, ALBANY, NY 12206-1098
(518) 459-8106
Mailing address
1 KENT PL, WYNANTSKILL, NY 12198-8787
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
032090-01
NY
Other
Enumeration date
07/29/2024
Last updated
07/29/2024
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