Provider Demographics
NPI:1841571650
Name:KANELLIS, AMY JANEEN
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JANEEN
Last Name:KANELLIS
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 1:2726 RALPHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-1228
Mailing Address - Country:US
Mailing Address - Phone:419-902-2402
Mailing Address - Fax:
Practice Address - Street 1:2726 RALPHWOOD DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-1228
Practice Address - Country:US
Practice Address - Phone:419-902-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN114378164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse