Provider Demographics
NPI:1538556626
Name:HORN, AMANDA LANE (NP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LANE
Last Name:HORN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090-8948
Mailing Address - Country:US
Mailing Address - Phone:440-647-2225
Mailing Address - Fax:440-647-5110
Practice Address - Street 1:840 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-8948
Practice Address - Country:US
Practice Address - Phone:440-647-2225
Practice Address - Fax:440-647-5110
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17112-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0127304Medicaid