Provider Demographics
NPI:1356594758
Name:COX - DEATON, AMANDA GENEVA (LPN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GENEVA
Last Name:COX - DEATON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:GENEVA
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7151 TRENTON FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1339
Mailing Address - Country:US
Mailing Address - Phone:513-393-0588
Mailing Address - Fax:
Practice Address - Street 1:8580 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-3946
Practice Address - Country:US
Practice Address - Phone:513-424-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.129113 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse