Provider Demographics
NPI:1184013153
Name:RODEN, AMY (NP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:RODEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 RONSAN ST SW
Mailing Address - Street 2:
Mailing Address - City:SUGARCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44681-9353
Mailing Address - Country:US
Mailing Address - Phone:330-204-9630
Mailing Address - Fax:866-444-3004
Practice Address - Street 1:1514 JEFFERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016337363LF0000X
MN7329363LF0000X
LA234519363LF0000X
MI4704289654363LF0000X
NDR49938363LF0000X
IL277.002324363LF0000X
OK205869363LF0000X
MS906525363LF0000X
KY3015618363LF0000X
IN01039833A363LF0000X
IAA177859363LF0000X
AL3-001662363LF0000X
OH16711363LF0000X
MT166322363LF0000X
NE114873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily