Provider Demographics
NPI:1265842116
Name:GANO, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60330 TOWNSHIP ROAD 104
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-9644
Mailing Address - Country:US
Mailing Address - Phone:330-440-4833
Mailing Address - Fax:
Practice Address - Street 1:60330 TOWNSHIP ROAD 104
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-9644
Practice Address - Country:US
Practice Address - Phone:330-440-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 12201-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse