Provider Demographics
NPI:1629336201
Name:DURBIN, AMANDA JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JO
Last Name:DURBIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:MATHENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15435 HOWARD DANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43014-9667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15435 HOWARD DANVILLE RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43014-9667
Practice Address - Country:US
Practice Address - Phone:740-398-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse