Provider Demographics
NPI:1679870174
Name:ALEXANDER, AMANDA E
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:E
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:138 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2060
Mailing Address - Country:US
Mailing Address - Phone:740-703-0439
Mailing Address - Fax:
Practice Address - Street 1:138 S SHORE DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2060
Practice Address - Country:US
Practice Address - Phone:740-703-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.342446163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse