Healthcare Provider Details

I. General information

NPI: 1215663166
Provider Name (Legal Business Name): AMY LEBER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY HUNTER

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4977 NORTHCUTT PL
DAYTON OH
45414-3839
US

IV. Provider business mailing address

647 ROCKHILL AVE
KETTERING OH
45429-3441
US

V. Phone/Fax

Practice location:
  • Phone: 937-387-6395
  • Fax:
Mailing address:
  • Phone: 937-823-2937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN386491
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.386491
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: