Provider Demographics
NPI:1679106983
Name:PFEIFFER, AMANDA L (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:PFEIFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 MAPLE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3134
Mailing Address - Country:US
Mailing Address - Phone:847-926-0106
Mailing Address - Fax:312-694-2020
Practice Address - Street 1:1704 MAPLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3134
Practice Address - Country:US
Practice Address - Phone:847-926-0106
Practice Address - Fax:312-694-2020
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
IL085008428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program