Provider Demographics
NPI:1629643242
Name:GRASSMAN, AMBER MARIE DWAN (RN/BSN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MARIE DWAN
Last Name:GRASSMAN
Suffix:
Gender:F
Credentials:RN/BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13984 LAKE COURT DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9291
Mailing Address - Country:US
Mailing Address - Phone:330-749-2044
Mailing Address - Fax:330-345-0001
Practice Address - Street 1:13984 LAKE COURT DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:OH
Practice Address - Zip Code:44618-9291
Practice Address - Country:US
Practice Address - Phone:330-749-2044
Practice Address - Fax:330-345-0001
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH364169163W00000X
OHAPRN.CNP.0033608363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse