Individual
MS. AMANDA BROOKE LAVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2301 S BROAD ST, PHILADELPHIA, PA 19148-3542
(215) 952-9559
(215) 952-9615
Mailing address
2301 S BROAD ST, PHILADELPHIA, PA 19148-3542
(215) 952-9559
(215) 952-9615
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA053731
PA
Other
Enumeration date
05/17/2010
Last updated
01/02/2014
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