Provider Demographics
NPI:1851163414
Name:LAYNE, AMELIA L
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:L
Last Name:LAYNE
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 1:3096 WASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9409
Mailing Address - Country:US
Mailing Address - Phone:567-224-0136
Mailing Address - Fax:
Practice Address - Street 1:3022 STATE ROUTE 99 S
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9559
Practice Address - Country:US
Practice Address - Phone:419-951-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty