Provider Demographics
NPI:1508466152
Name:MAYLE, AMANDA JWELL
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JWELL
Last Name:MAYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 BUCKEYE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERHILL
Mailing Address - State:OH
Mailing Address - Zip Code:43728-9049
Mailing Address - Country:US
Mailing Address - Phone:740-461-0591
Mailing Address - Fax:
Practice Address - Street 1:227 BUCKEYE RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTERHILL
Practice Address - State:OH
Practice Address - Zip Code:43728-9049
Practice Address - Country:US
Practice Address - Phone:740-461-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide