Provider Demographics
NPI:1790063444
Name:WILLIAMSON, AMY MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:WILLIAMSON
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 1:2233 BROOKSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3992
Mailing Address - Country:US
Mailing Address - Phone:937-477-0564
Mailing Address - Fax:
Practice Address - Street 1:2111 BEAVER VALLEY RD.
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434
Practice Address - Country:US
Practice Address - Phone:937-431-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.098037-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse