Healthcare Provider Details

I. General information

NPI: 1649744384
Provider Name (Legal Business Name): AMANDA L GILLENWATER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARK AVE
IRONTON OH
45638-1502
US

IV. Provider business mailing address

700 PARK AVE
IRONTON OH
45638-1502
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-1613
  • Fax: 740-532-1715
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0027743
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.454549
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: