Provider Demographics
NPI:1639360456
Name:GOLDSWORTHY, AMANDA EMILY (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:EMILY
Last Name:GOLDSWORTHY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:EMILY
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7340 BRANDTVISTA AVE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3331
Mailing Address - Country:US
Mailing Address - Phone:937-237-1196
Mailing Address - Fax:
Practice Address - Street 1:7340 BRANDTVISTA AVE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3331
Practice Address - Country:US
Practice Address - Phone:937-237-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH276474163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2122410Medicaid