Look up the most recent NPI and PECOS records

Amanda A. Gudknecht

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3400 Spruce Street, Ground Floor Ravdin, Philadelphia, PA 19104

PECOS Enrollment

This provider is enrolled in PECOS as AMANDA GUDKNECHT.

Based on the most recent information from CMS, provider Amanda A. Gudknecht is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1871691733
Provider Type
Individual
Full Name
Gudknecht, Amanda A.
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
9/21/2006
Last Updated
2/13/2014

Contact Information

Practice Location

3400 Spruce Street, Ground Floor Ravdin, Philadelphia, PA 19104

(215) 662-6698

Unlisted Fax

Mailing Location

3400 Spruce Street, Ground Floor Ravdin, Philadelphia, PA 19104

(215) 662-6698

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License MA052159 Pennsylvania
Code 363AM0700X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 25MP00148000 New Jersey

Amanda A. Gudknecht

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Brunker, Tamara M

Jacob, Nancy Anne

Gitter, Benjamin

Hogan, Kamini B

Monterrosa, Christina

Chester, Shannon Mary

Mcdonough, Andrea

Profit, Tasha D

Raihl, Olivia Paige

Engeland, Megan Elizabeth