Provider Demographics
NPI:1801154620
Name:WATSON, AMANDA JOLENE (RN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOLENE
Last Name:WATSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOLENE
Other - Last Name:CLABAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2902 LONG RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5534
Mailing Address - Country:US
Mailing Address - Phone:330-410-3017
Mailing Address - Fax:
Practice Address - Street 1:2902 LONG RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5534
Practice Address - Country:US
Practice Address - Phone:330-410-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN360381163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse