Provider Demographics
NPI:1235860503
Name:BASHLINE, AMANDA MAE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MAE
Last Name:BASHLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 EASTLAND AVE SE STE 302
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4501
Mailing Address - Country:US
Mailing Address - Phone:330-841-4975
Mailing Address - Fax:330-841-4979
Practice Address - Street 1:627 EASTLAND AVE SE STE 302
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4501
Practice Address - Country:US
Practice Address - Phone:330-841-4975
Practice Address - Fax:330-841-4979
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife