Healthcare Provider Details

I. General information

NPI: 1700770070
Provider Name (Legal Business Name): AMANDA L. PUMMELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MIAMI VALLEY DR STE 310
CENTERVILLE OH
45459-4778
US

IV. Provider business mailing address

4188 MAXWELL DR
BELLBROOK OH
45305-1627
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-5216
  • Fax:
Mailing address:
  • Phone: 330-464-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0039367
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: