Provider Demographics
NPI:1164004230
Name:RADER, AMY (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:RADER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 TOWNSHIP ROAD 1600
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9211
Mailing Address - Country:US
Mailing Address - Phone:419-606-7357
Mailing Address - Fax:
Practice Address - Street 1:2212 MIFFLIN AVE STE 130
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8846
Practice Address - Country:US
Practice Address - Phone:419-606-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH025798363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner