Individual
AMANDA PANEPENTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
220 E ROGERS RD, LONGMONT, CO 80501-6027
(303) 697-2583
(303) 682-6419
Mailing address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0006718
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/26/2019
Last updated
06/03/2021
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