Provider Demographics
NPI:1710508064
Name:APPLEGATE, AMELIA GWYN (LPN)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:GWYN
Last Name:APPLEGATE
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 1:130 WAYNE FRYE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45144-9314
Mailing Address - Country:US
Mailing Address - Phone:937-549-4777
Mailing Address - Fax:937-549-2186
Practice Address - Street 1:130 WAYNE FRYE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45144-9314
Practice Address - Country:US
Practice Address - Phone:937-549-4777
Practice Address - Fax:937-549-2186
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111232164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse