Provider Demographics
NPI:1023546843
Name:CREEL, AMANDA L (NP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:CREEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:HANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:611 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1381
Mailing Address - Country:US
Mailing Address - Phone:315-788-1530
Mailing Address - Fax:315-755-2538
Practice Address - Street 1:611 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1337
Practice Address - Country:US
Practice Address - Phone:315-788-1530
Practice Address - Fax:315-788-4759
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY551870163WP0808X
NY402158363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health