Provider Demographics
NPI:1316145915
Name:ORNELAS, AMY LYNN (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:ORNELAS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7454 HICKORY LOG CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5004
Mailing Address - Country:US
Mailing Address - Phone:410-290-3751
Mailing Address - Fax:
Practice Address - Street 1:7454 HICKORY LOG CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5004
Practice Address - Country:US
Practice Address - Phone:410-290-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR165962163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse