Provider Demographics
NPI:1174590004
Name:CROMER, AMANDA N (NP-C, AOCNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:CROMER
Suffix:
Gender:F
Credentials:NP-C, AOCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400 SOUTHEAST RADIATION ONCOLOGY GROUP
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3264
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:SUITE 3809 CAROLINAS MEDICAL CENTER-RADIATION ONCOLOGY
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-2272
Practice Address - Fax:704-333-3397
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900460363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592234OtherMEDICARE PTAN
NC259223AOtherMEDICARE PTAN
NC259223BOtherMEDICARE PTAN
NC2592234OtherMEDICARE PTAN