Provider Demographics
NPI:1902223456
Name:LYNN, AMANDA EILEEN (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:EILEEN
Last Name:LYNN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:EILEEN
Other - Last Name:HERRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8000 5 MILE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2189
Mailing Address - Country:US
Mailing Address - Phone:513-559-7175
Mailing Address - Fax:740-592-9286
Practice Address - Street 1:8000 5 MILE RD STE 205
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2190
Practice Address - Country:US
Practice Address - Phone:513-559-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.013389207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program