Provider Demographics
NPI:1497090443
Name:CONNOR, AMY LOUISE (CNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD STE 250
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6102
Mailing Address - Country:US
Mailing Address - Phone:419-520-2495
Mailing Address - Fax:
Practice Address - Street 1:1710 COLUMBUS PIKE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2726
Practice Address - Country:US
Practice Address - Phone:740-549-2700
Practice Address - Fax:740-615-1549
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.13905363LF0000X
OR201403299NP-PP363LF0000X, 363LF0000X
OHRN.370017163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0310289Medicaid