Provider Demographics
NPI:1053779124
Name:POLING, AMY (MSN ED, RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:POLING
Suffix:
Gender:F
Credentials:MSN ED, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9333
Mailing Address - Country:US
Mailing Address - Phone:614-836-4964
Mailing Address - Fax:
Practice Address - Street 1:4475 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9333
Practice Address - Country:US
Practice Address - Phone:614-836-4964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.318087163WP0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WP0200XNursing Service ProvidersRegistered NursePediatrics