Provider Demographics
NPI:1679208706
Name:VAZQUEZ, AMANDA ALEXIS
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALEXIS
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 BEAVER RIDGE DR APT C
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4058
Mailing Address - Country:US
Mailing Address - Phone:937-802-6815
Mailing Address - Fax:
Practice Address - Street 1:1568 BEAVER RIDGE DR APT C
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4058
Practice Address - Country:US
Practice Address - Phone:937-802-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion