Provider Demographics
NPI:1801380712
Name:HALE, AMANDA RENEE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:HALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4652 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-9356
Mailing Address - Country:US
Mailing Address - Phone:330-933-0190
Mailing Address - Fax:
Practice Address - Street 1:4652 PARADISE RD
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273
Practice Address - Country:US
Practice Address - Phone:330-933-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.326242163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse