Provider Demographics
NPI:1871878199
Name:HOOSE, AMANDA ANN (C-NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN
Last Name:HOOSE
Suffix:
Gender:F
Credentials:C-NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ANN
Other - Last Name:MAGOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20455 LORAIN ROAD
Mailing Address - Street 2:SUITE T01
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3495
Mailing Address - Country:US
Mailing Address - Phone:440-799-4224
Mailing Address - Fax:440-799-4228
Practice Address - Street 1:9050 N CHURCH DR
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4701
Practice Address - Country:US
Practice Address - Phone:440-292-0226
Practice Address - Fax:440-292-0228
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12792-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH061572Medicare PIN