Healthcare Provider Details

I. General information

NPI: 1982152302
Provider Name (Legal Business Name): MRS. AMANDA KATHLEEN WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KATHLEEN SCHWAB APRN-CNP

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-7425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019737
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: