Provider Demographics
NPI:1033479597
Name:ADDISON, AMIE NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:NICOLE
Last Name:ADDISON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 WESTMONT LN
Mailing Address - Street 2:APT 1601
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-1159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1914 WESTMONT LN
Practice Address - Street 2:APT 1601
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-1159
Practice Address - Country:US
Practice Address - Phone:513-739-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.145081-M-IV164W00000X
OH400586530207374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide