Provider Demographics
NPI:1245305051
Name:AMFAHR, CAROL A (CNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:AMFAHR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SOUTHERN BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1226
Mailing Address - Country:US
Mailing Address - Phone:855-500-2873
Mailing Address - Fax:937-281-3913
Practice Address - Street 1:3700 SOUTHERN BLVD STE 401
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1226
Practice Address - Country:US
Practice Address - Phone:855-500-2873
Practice Address - Fax:937-281-3913
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 08082 NP363LA2200X
OHAPRN.CNP.08082363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000000363681OtherANTHEM
OH2543493Medicaid
OH$$$$$$$$$001OtherMEDICAL MUTUAL
OHQ33416Medicare UPIN
OH2543493Medicaid
OHH355901Medicare PIN