Healthcare Provider Details

I. General information

NPI: 1508467010
Provider Name (Legal Business Name): AMANDA DAWN SMITH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 01/07/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1566 MONMOUTH DR STE 101
LANCASTER OH
43130-8048
US

IV. Provider business mailing address

1566 MONMOUTH DR STE 101
LANCASTER OH
43130-8048
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-1177
  • Fax:
Mailing address:
  • Phone: 740-687-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006613RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: