Provider Demographics
NPI:1164858197
Name:PERKINS, AMANDA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44915 W CAPTINA HIGHWAY RD
Mailing Address - Street 2:
Mailing Address - City:ALLEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:43902-9719
Mailing Address - Country:US
Mailing Address - Phone:740-213-4859
Mailing Address - Fax:
Practice Address - Street 1:44915 W CAPTINA HIGHWAY RD
Practice Address - Street 2:
Practice Address - City:ALLEDONIA
Practice Address - State:OH
Practice Address - Zip Code:43902-9719
Practice Address - Country:US
Practice Address - Phone:740-213-4859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.394115163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse