Provider Demographics
NPI:1710159058
Name:AMAGWU, ANTHONY C (CNP)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:C
Last Name:AMAGWU
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:6680 POE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2855
Mailing Address - Country:US
Mailing Address - Phone:937-280-8400
Mailing Address - Fax:937-280-8373
Practice Address - Street 1:2350 MIAMI VALLEY DR STE 500
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4780
Practice Address - Country:US
Practice Address - Phone:937-293-1622
Practice Address - Fax:937-245-6308
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN-306803-COA1163W00000X, 163W00000X
OHAPRN.CNP.09916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2831538Medicaid
OHH207302Medicare PIN
OH2831538Medicaid