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General NPI Number Information
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NPI Number | 1891192985
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Entity Type | Individual
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Provider Name | AMANDA KATHLEEN DAVIS MSN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 4302 ALLEN RD STE 420
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City | STOW
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State | OH
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Zip | 44224-1070
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Country | US
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Telephone | 330-865-4644
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Fax | 330-865-4641
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Provider Business Mailing Address
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Address Line | 63 BAKER BLVD
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City | FAIRLAWN
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State | OH
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Zip | 44333-3601
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Country | US
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Telephone | 330-572-0645
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Fax | 330-572-0645
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 16668-NP
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License Number State | OH
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