Provider Demographics
NPI:1659518991
Name:JOHNSON GRUND, AMELIA FAYE (PMH, NP-BC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:FAYE
Last Name:JOHNSON GRUND
Suffix:
Gender:F
Credentials:PMH, NP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:336 GLESSNER AVE
Practice Address - Street 2:MOB 2ND FL
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903
Practice Address - Country:US
Practice Address - Phone:419-520-2826
Practice Address - Fax:419-526-8284
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.10350363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health