Healthcare Provider Details

I. General information

NPI: 1164749370
Provider Name (Legal Business Name): AMY S HANDERMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3871 BLOSSOM CT
MASON OH
45040-4118
US

IV. Provider business mailing address

3871 BLOSSOM CT
MASON OH
45040-4118
US

V. Phone/Fax

Practice location:
  • Phone: 513-314-7210
  • Fax: 513-754-1488
Mailing address:
  • Phone: 513-314-7210
  • Fax: 513-754-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN192109
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: