Provider Demographics
NPI:1275883373
Name:DEROSA, AMANDA FAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:FAY
Last Name:DEROSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W SATIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-1339
Mailing Address - Country:US
Mailing Address - Phone:440-813-7463
Mailing Address - Fax:
Practice Address - Street 1:134 W SATIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1339
Practice Address - Country:US
Practice Address - Phone:440-813-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.384623163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health