Provider Demographics
NPI:1942652532
Name:MICHEL, AMANDA (RN, MS, AG-ACNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MICHEL
Suffix:
Gender:F
Credentials:RN, MS, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 MACK RD
Mailing Address - Street 2:STE 310
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5376
Mailing Address - Country:US
Mailing Address - Phone:513-420-8030
Mailing Address - Fax:513-425-7202
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:STE 180
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5200
Practice Address - Country:US
Practice Address - Phone:513-420-8030
Practice Address - Fax:513-425-7202
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.379433163W00000X
OHAPRN.CNP.019344363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH488290Medicare PIN