Basic Information
| Provider Information | |||||||||
| NPI: | 1073794269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAGLIOLI | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 317 APPLE DR | ||||||||
| Address2: | |||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804873074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704616140 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1041 MONTGOMERY STREET | ||||||||
| Address2: | |||||||||
| City: | CUSTER | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577301304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056734150 | ||||||||
| FaxNumber: | 6056733917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2007 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0513 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.