Provider Demographics
NPI:1417694530
Name:LARE, AMANDA JONETTE (LPN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JONETTE
Last Name:LARE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-1339
Mailing Address - Country:US
Mailing Address - Phone:330-206-7249
Mailing Address - Fax:
Practice Address - Street 1:13969 GERMAN CHURCH RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:OH
Practice Address - Zip Code:44201-9016
Practice Address - Country:US
Practice Address - Phone:330-206-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172225164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse