Provider Demographics
NPI:1134639958
Name:HORNAMAN, AMIE (MSN, CFMP)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:HORNAMAN
Suffix:
Gender:F
Credentials:MSN, CFMP
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:HORNAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 FILMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2984
Mailing Address - Country:US
Mailing Address - Phone:412-400-0828
Mailing Address - Fax:
Practice Address - Street 1:2222 FILMORE AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2984
Practice Address - Country:US
Practice Address - Phone:412-400-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA81-3827215OtherEIN NUMBER