Healthcare Provider Details

I. General information

NPI: 1023887106
Provider Name (Legal Business Name): AMIE MARIE STANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5414 VINEWOOD CT
COLUMBUS OH
43229-4466
US

IV. Provider business mailing address

5414 VINEWOOD CT
COLUMBUS OH
43229-4466
US

V. Phone/Fax

Practice location:
  • Phone: 614-778-1078
  • Fax:
Mailing address:
  • Phone: 614-778-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRR020777
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: