Provider Demographics
NPI:1356885669
Name:SARGE, AMY SUE (LPN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:SARGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16538 LONGS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-8914
Mailing Address - Country:US
Mailing Address - Phone:330-843-6412
Mailing Address - Fax:
Practice Address - Street 1:16538 LONGS CHURCH RD
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-8914
Practice Address - Country:US
Practice Address - Phone:330-843-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH108849164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse