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NPI Code Detail

MEDICARE: MS. AMANDA M BOHANNON FNP-BC

MEDICARE: MS. AMANDA M BOHANNON FNP-BC
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
1363LF0000XFamily Nurse PractitionerCOA.17292-NPOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356723902
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA M BOHANNON FNP-BC
Provider Business Mailing Address
First Line : 12110 LEBANON RD
Second Line :
City : SHARONVILLE
State : OH
Zip : 45241-1739
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12110 LEBANON RD
Second Line :
City : SHARONVILLE
State : OH
Zip : 45241-1739
Country : US
Telephone Number : 513-853-9700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2015
Last Update Date : 09/20/2021

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