Provider Demographics
NPI:1679393516
Name:MATLA, AMY E (CRNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:MATLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5265 ROCKROSE LN BLDG J38
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-8265
Mailing Address - Country:US
Mailing Address - Phone:484-894-7991
Mailing Address - Fax:
Practice Address - Street 1:6081 HAMILTON BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9801
Practice Address - Country:US
Practice Address - Phone:440-517-8946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024857363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner