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General NPI Number Information
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NPI Number | 1215480900
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Entity Type | Individual
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Provider Name | AMANDA CLARK CNP
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Gender | Female
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 2139 AUBURN AVE
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 513-206-1180
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Fax |
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Provider Business Mailing Address
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Address Line | 237 WILLIAM HOWARD TAFT RD 2ND FLOOR, CBO 2-3
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City | CINCINNATI
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State | OH
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Zip | 45219-2610
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Country | US
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Telephone | 513-206-1180
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN302986
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | NP-019707
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License Number State | OH
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