Provider Demographics
NPI:1609134113
Name:COLE, AMARA D
Entity Type:Individual
Prefix:
First Name:AMARA
Middle Name:D
Last Name:COLE
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 1:4695 WALFORD RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WARRENSVILLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128
Mailing Address - Country:US
Mailing Address - Phone:216-894-1129
Mailing Address - Fax:
Practice Address - Street 1:4695 WALFORD RD
Practice Address - Street 2:APT 15
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5129
Practice Address - Country:US
Practice Address - Phone:216-894-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN137766164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse