Provider Demographics
NPI:1497074439
Name:BARTLETT, AMY B (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6298 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9307
Mailing Address - Country:US
Mailing Address - Phone:937-725-7897
Mailing Address - Fax:
Practice Address - Street 1:6298 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45044-9307
Practice Address - Country:US
Practice Address - Phone:937-725-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138863164W00000X
OH374430163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse