Healthcare Provider Details

I. General information

NPI: 1629336201
Provider Name (Legal Business Name): AMANDA JO DURBIN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS AMANDA JO MATHENY

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 HOWARD DANVILLE RD
DANVILLE OH
43014-9667
US

IV. Provider business mailing address

15435 HOWARD DANVILLE RD
DANVILLE OH
43014-9667
US

V. Phone/Fax

Practice location:
  • Phone: 740-398-3262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number374494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: