Provider Demographics
NPI:1265300800
Name:CRISWELL-ZENNI, AMANDA GRACE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GRACE
Last Name:CRISWELL-ZENNI
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:MRS
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:ZENNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, PMHNP-BC
Mailing Address - Street 1:650 N MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-9627
Mailing Address - Country:US
Mailing Address - Phone:513-498-3236
Mailing Address - Fax:
Practice Address - Street 1:650 N MIAMI AVE
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-9627
Practice Address - Country:US
Practice Address - Phone:513-498-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0040607363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health