Provider Demographics
NPI:1265095822
Name:WARD, AMY SUZANNE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1975
Mailing Address - Country:US
Mailing Address - Phone:937-407-3571
Mailing Address - Fax:
Practice Address - Street 1:504 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1975
Practice Address - Country:US
Practice Address - Phone:937-407-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist