Provider Demographics
NPI:1497009880
Name:WELCH, AMANDA JEAN (STNA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:WELCH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:549 STATE ROUTE 603
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:OH
Mailing Address - Zip Code:44837-9632
Mailing Address - Country:US
Mailing Address - Phone:419-606-6234
Mailing Address - Fax:
Practice Address - Street 1:549 STATE ROUTE 603
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:OH
Practice Address - Zip Code:44837-9632
Practice Address - Country:US
Practice Address - Phone:419-606-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401304991011376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide