Provider Demographics
NPI:1417702192
Name:JOSEPH, AMANDA MAE (IP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10491 LEAVERTON RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-8436
Mailing Address - Country:US
Mailing Address - Phone:740-463-1646
Mailing Address - Fax:
Practice Address - Street 1:4 WILLIS CT
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1073
Practice Address - Country:US
Practice Address - Phone:740-572-7469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty