Provider Demographics
NPI:1881902526
Name:TAYLOR, AMANDA L (LPN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:TAYLOR
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 1:2399 ROUSH HILL RD.
Mailing Address - Street 2:PO BOX 83
Mailing Address - City:MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45144-9130
Mailing Address - Country:US
Mailing Address - Phone:937-549-1728
Mailing Address - Fax:
Practice Address - Street 1:2399 ROUSH HILL RD.
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45144-9130
Practice Address - Country:US
Practice Address - Phone:937-549-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.123688-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse