Provider Demographics
NPI:1225561467
Name:PEDS ON WHEELS
Entity Type:Organization
Organization Name:PEDS ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:419-217-7635
Mailing Address - Street 1:167 E WASHINGTON ROW
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2609
Mailing Address - Country:US
Mailing Address - Phone:419-217-7635
Mailing Address - Fax:567-214-4101
Practice Address - Street 1:167 E WASHINGTON ROW
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2609
Practice Address - Country:US
Practice Address - Phone:419-217-7635
Practice Address - Fax:567-214-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty