Provider Demographics
NPI:1760890230
Name:KOTTYAN, AMANDA LEE (CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:KOTTYAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:DOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:5050 SECTION AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2055
Mailing Address - Country:US
Mailing Address - Phone:513-946-7610
Mailing Address - Fax:513-946-7603
Practice Address - Street 1:5050 SECTION AVE FL 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2055
Practice Address - Country:US
Practice Address - Phone:513-946-7610
Practice Address - Fax:513-946-7603
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 16267 NP363LW0102X
OH16267NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health