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NPI Code Detail

MEDICARE: AMY CUPP RN

MEDICARE: AMY CUPP RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse324005OH

General Provider Information

NPI Number : 1184070559
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY CUPP RN
Provider Business Mailing Address
First Line : 67670 TRACO DR
Second Line :
City : SAINT CLAIRSVILLE
State : OH
Zip : 43950-9375
Country : US
Telephone Number : 740-695-2131
Fax Number : 740-695-7106
Provider Business Practice Location Address
First Line : 67670 TRACO DR
Second Line :
City : SAINT CLAIRSVILLE
State : OH
Zip : 43950-9375
Country : US
Telephone Number : 740-695-2131
Fax Number : 740-695-7106
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2016
Last Update Date : 05/04/2016

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