Wallace, Amanda Gail

Wallace, Amanda Gail is an individual health care provider with primary practice located at 247 Cic Blvd , West Union OH 45693-7512. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Nursing Service Providers / Registered Nurse. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Wallace, Amanda Gail can be contacted via phone (513) 941-4999.

Contact Information

Primary practice address
247 Cic Blvd West Union OH 45693-7512
Phone: (513) 941-4999
Fax: (513) 694-0168
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 3011658 Kentucky
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APRN.CNP.021126 Ohio
Nursing Service Providers / Registered Nurse 163W00000X RN.300987 Ohio
Nursing Service Providers / Registered Nurse 163W00000X 1155351 Kentucky

Profile Details

NPI number 1154844041
LBN Legal business name Wallace, Amanda Gail
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2017
Last updated May 5th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154844041 NPPES
Ohio MEDICAID 0241010
Ohio MEDICAID 7100477320

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