Individual
DR. AMANDA AMMENTORP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3458 NEELY RD, MC GUIRE AFB, NJ 08641-5312
(866) 377-2778
Mailing address
3458 NEELY RD, MC GUIRE AFB, NJ 08641-5312
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OT022056
PA
2083A0100X
Aerospace Medicine Physician
68149
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952868606
NPI
—
Enumeration date
02/28/2019
Last updated
06/30/2026
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