Provider Demographics
NPI:1831323443
Name:GAINES, AMY JOANN (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JOANN
Last Name:GAINES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 SWAUGER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8637
Mailing Address - Country:US
Mailing Address - Phone:740-820-5646
Mailing Address - Fax:
Practice Address - Street 1:5824 SWAUGER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-8637
Practice Address - Country:US
Practice Address - Phone:740-820-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 285682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse