Provider Demographics
NPI:1447098066
Name:HALE, AMANDA MARIE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:HALE
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 1:104 INDIAN HILL DRIVE
Mailing Address - Street 2:PO.BOX 312
Mailing Address - City:GRATIS
Mailing Address - State:OH
Mailing Address - Zip Code:45330-0312
Mailing Address - Country:US
Mailing Address - Phone:937-728-9468
Mailing Address - Fax:
Practice Address - Street 1:104 INDIAN HILL DRIVE
Practice Address - Street 2:PO.BOX 312
Practice Address - City:GRATIS
Practice Address - State:OH
Practice Address - Zip Code:45330-0312
Practice Address - Country:US
Practice Address - Phone:937-728-9468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant