Provider Demographics
NPI:1639439094
Name:WEISSMANN, AMANDA JOYCE (RN NP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOYCE
Last Name:WEISSMANN
Suffix:
Gender:F
Credentials:RN NP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOYCE
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN-APRN
Mailing Address - Street 1:24140 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-7612
Mailing Address - Country:US
Mailing Address - Phone:513-582-7627
Mailing Address - Fax:
Practice Address - Street 1:3700 ALEXANDRIA PIKE STE B
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-1792
Practice Address - Country:US
Practice Address - Phone:859-999-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-20
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008640A363L00000X
IN28207606A163W00000X
KY1143247163W00000X
OHRN.380473163W00000X
OHAPRN.CNP.023377363LF0000X
KY3012690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1639439094Medicaid