Provider Demographics
NPI:1154540391
Name:CROOKS, AMY LYNN (LPN)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:CROOKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:BRIGHTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:444 BOYCE ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1461
Mailing Address - Country:US
Mailing Address - Phone:937-652-2822
Mailing Address - Fax:
Practice Address - Street 1:1150 SCIOTO ST STE 200
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2291
Practice Address - Country:US
Practice Address - Phone:937-652-4555
Practice Address - Fax:937-652-4945
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN110857374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel