Provider Demographics
NPI:1568945590
Name:MCALLEN, AMANDA MAE (CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:MCALLEN
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 1:6505 MARKET ST BLDG A1
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3457
Mailing Address - Country:US
Mailing Address - Phone:330-746-8040
Mailing Address - Fax:330-746-8025
Practice Address - Street 1:6505 MARKET ST BLDG A1
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3457
Practice Address - Country:US
Practice Address - Phone:330-746-8040
Practice Address - Fax:330-746-8025
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.361009163W00000X
OHAPRN.CNP.023509363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse