Provider Demographics
NPI:1073869863
Name:AMSTUTZ, ERIC W (CNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:AMSTUTZ
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-981-5123
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:825 W MARKET ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2799
Practice Address - Country:US
Practice Address - Phone:419-996-5780
Practice Address - Fax:419-996-5781
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069960Medicaid
OHH146810Medicare PIN