Provider Demographics
NPI:1639645484
Name:CASTRO, AMY JO (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:CASTRO
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 1:1265 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3531
Mailing Address - Country:US
Mailing Address - Phone:724-977-4313
Mailing Address - Fax:
Practice Address - Street 1:1265 HALL AVE
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3531
Practice Address - Country:US
Practice Address - Phone:724-977-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN302486164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse