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General NPI Number Information
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NPI Number | 1093074262
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Entity Type | Individual
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Provider Name | AMANDA RUTH PETERMAN LPN
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Gender | Female
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 2219 N WATER STREET EXT
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City | UHRICHSVILLE
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State | OH
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Zip | 44683-1049
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Country | US
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Telephone | 330-447-3263
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Fax |
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Provider Business Mailing Address
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Address Line | 2262 FILLMANS BOTTOM RD SW
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City | PORT WASHINGTON
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State | OH
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Zip | 43837-9134
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Country | US
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Telephone | 330-447-3263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN141408 M IV
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License Number State | OH
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