Provider Demographics
NPI:1700203882
Name:HARBER, AMOS
Entity Type:Individual
Prefix:
First Name:AMOS
Middle Name:
Last Name:HARBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 ADELPHIA STATE RD
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-9711
Mailing Address - Country:US
Mailing Address - Phone:740-703-8641
Mailing Address - Fax:
Practice Address - Street 1:1180 ADELPHIA STATE RD
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-9711
Practice Address - Country:US
Practice Address - Phone:740-703-8641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.137818-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse