Provider Demographics
NPI:1245641216
Name:MORANVILLE, AMY DIANE (RN, CPN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:MORANVILLE
Suffix:
Gender:F
Credentials:RN, CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6075 DEERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2808
Mailing Address - Country:US
Mailing Address - Phone:937-409-5378
Mailing Address - Fax:
Practice Address - Street 1:6075 DEERFIELD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2808
Practice Address - Country:US
Practice Address - Phone:937-409-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390169163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics