Healthcare Provider Details

I. General information

NPI: 1245602135
Provider Name (Legal Business Name): AMANDA KYRENE GENDREW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 GHOLSON AVE # 7
CINCINNATI OH
45229-2303
US

IV. Provider business mailing address

661 GHOLSON AVE # 7
CINCINNATI OH
45229-2303
US

V. Phone/Fax

Practice location:
  • Phone: 513-817-7953
  • Fax:
Mailing address:
  • Phone: 513-817-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number400976630909
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number400976630909
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number400976630909
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400976630909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: