Provider Demographics
NPI:1467436832
Name:AMIET, MICHAEL T (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:AMIET
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BEDWEN BACH LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-1519
Mailing Address - Country:US
Mailing Address - Phone:740-920-4286
Mailing Address - Fax:
Practice Address - Street 1:102 BEDWEN BACH LN
Practice Address - Street 2:SUITE B
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1519
Practice Address - Country:US
Practice Address - Phone:740-920-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN278276163W00000X
OHNA07971367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse