Provider Demographics
NPI:1639771223
Name:SMITH, AMANDA CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-1411
Mailing Address - Country:US
Mailing Address - Phone:419-296-3652
Mailing Address - Fax:
Practice Address - Street 1:707 E ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1411
Practice Address - Country:US
Practice Address - Phone:419-296-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide