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General NPI Number Information
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NPI Number | 1669216495
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Entity Type | Individual
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Provider Name | AMANDA EMMALENE ROSE CALDWELL CNP
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Gender | Female
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Dates
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Enumeration Date | 06/25/2024
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 2131 E STATE ST
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City | ATHENS
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State | OH
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Zip | 45701-2138
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Country | US
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Telephone | 855-446-5937
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Fax |
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Provider Business Mailing Address
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Address Line | 90 JACKSON PIKE
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1560
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Country | US
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Telephone | 740-446-5000
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.0036704
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License Number State | OH
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