Healthcare Provider Details

I. General information

NPI: 1699554055
Provider Name (Legal Business Name): AMANDA N LORTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SPRINGER WOODS BLVD
DELAWARE OH
43015-5000
US

IV. Provider business mailing address

124 SPRINGER WOODS BLVD
DELAWARE OH
43015-5000
US

V. Phone/Fax

Practice location:
  • Phone: 614-307-1092
  • Fax:
Mailing address:
  • Phone: 614-307-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: