Provider Demographics
NPI:1609181544
Name:BAUMGARDNER, AMY LEIGH (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:BAUMGARDNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 PETRE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8751
Mailing Address - Country:US
Mailing Address - Phone:937-325-4742
Mailing Address - Fax:
Practice Address - Street 1:3916 PETRE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8751
Practice Address - Country:US
Practice Address - Phone:937-325-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.116727-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse