Provider Demographics
NPI:1467704742
Name:MULLINS, AMANDA ROSE (RN, NP-C)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:ROSE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6823 BRAMBLE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3211
Mailing Address - Country:US
Mailing Address - Phone:133-684-1265
Mailing Address - Fax:134-401-9805
Practice Address - Street 1:6823 BRAMBLE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-3211
Practice Address - Country:US
Practice Address - Phone:513-368-4126
Practice Address - Fax:513-440-1980
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0712656363LF0000X
OHAPRN.CNP.14312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082802Medicaid
12517785OtherCAQH
OHH178071Medicare PIN