Provider Demographics
NPI:1083851521
Name:SAUSEDA, AMANDA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:SAUSEDA
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 1:1237 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-4610
Mailing Address - Country:US
Mailing Address - Phone:419-701-9899
Mailing Address - Fax:419-436-0235
Practice Address - Street 1:1237 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-4610
Practice Address - Country:US
Practice Address - Phone:419-701-9899
Practice Address - Fax:419-436-0235
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH115849164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse