Provider Demographics
NPI:1639412240
Name:LANEY, AMANDA DAWN (LPN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:LANEY
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 1:5663 NATALIE CT N
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4128
Mailing Address - Country:US
Mailing Address - Phone:614-989-6706
Mailing Address - Fax:
Practice Address - Street 1:5663 NATALIE CT N
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4128
Practice Address - Country:US
Practice Address - Phone:614-989-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.116027-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse