Provider Demographics
NPI:1164189429
Name:AMIN, ROSE MANKA (APRN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MANKA
Last Name:AMIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 PACKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3709
Mailing Address - Country:US
Mailing Address - Phone:937-367-5957
Mailing Address - Fax:
Practice Address - Street 1:6830 PACKINGHAM DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-3709
Practice Address - Country:US
Practice Address - Phone:937-367-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0029754363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health