Provider Demographics
NPI:1417192824
Name:NOTTINGHAM, AMY JEAN (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:NOTTINGHAM
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 1:2708 OLD ENGLISH CT
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-7833
Mailing Address - Country:US
Mailing Address - Phone:817-571-8625
Mailing Address - Fax:
Practice Address - Street 1:2708 OLD ENGLISH CT
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-7833
Practice Address - Country:US
Practice Address - Phone:817-571-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX605564163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse