Individual
AMANDA LYNNE HATALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3400 SPRUCE STREET, 4 SILVERSTEIN, PHILADELPHIA, PA 19104-4206
(215) 662-2626
(215) 349-8195
Mailing address
3400 SPRUCE STREET, 4 SILVERSTEIN, PHILADELPHIA, PA 19104-4206
(215) 662-2626
(215) 349-8195
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA053418
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23-2359401
MAIN LINE HEALTHCARE TAX ID
PA
Enumeration date
11/09/2010
Last updated
08/14/2019
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