Provider Demographics
NPI:1073992863
Name:LOLLINI, AMANDA (RN, FNP - C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LOLLINI
Suffix:
Gender:F
Credentials:RN, FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17853 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8520
Mailing Address - Country:US
Mailing Address - Phone:937-578-4004
Mailing Address - Fax:937-578-4024
Practice Address - Street 1:17853 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8520
Practice Address - Country:US
Practice Address - Phone:937-578-4004
Practice Address - Fax:937-578-4024
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 362197163W00000X
OHCOA.17376-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse