Provider Demographics
NPI:1811017411
Name:LASS, AMANDA JO (CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:LASS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 AUBURN AVE
Mailing Address - Street 2:STE 334
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-585-1500
Mailing Address - Fax:513-585-1510
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:STE 334
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-1500
Practice Address - Fax:513-585-1510
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09324363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3011789Medicaid
OHNP32811Medicare PIN