Provider Demographics
NPI:1093005944
Name:TITUS, AMBER MAY (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:MAY
Last Name:TITUS
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 1:573 HERITAGE SQ
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-1207
Mailing Address - Country:US
Mailing Address - Phone:440-344-1333
Mailing Address - Fax:
Practice Address - Street 1:573 HERITAGE SQ
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1207
Practice Address - Country:US
Practice Address - Phone:440-344-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131332164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse