Healthcare Provider Details

I. General information

NPI: 1104413616
Provider Name (Legal Business Name): AMY LYNN ATTWOOD-CHARLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 MAIN ST APT 1
CINCINNATI OH
45202-7696
US

IV. Provider business mailing address

1427 MAIN ST APT 1
CINCINNATI OH
45202-7696
US

V. Phone/Fax

Practice location:
  • Phone: 801-231-3217
  • Fax:
Mailing address:
  • Phone: 801-231-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberIR.0968520
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: