Provider Demographics
NPI:1801407655
Name:BURNS, AMANDA (SWT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:OH
Mailing Address - Zip Code:45628-9590
Mailing Address - Country:US
Mailing Address - Phone:740-703-8425
Mailing Address - Fax:
Practice Address - Street 1:114 RENICK AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2879
Practice Address - Country:US
Practice Address - Phone:740-851-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2001398-TRNE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program