Provider Demographics
NPI:1366522674
Name:WILSON, AMANDA LYNN (RNFA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6091 CARMELL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228
Mailing Address - Country:US
Mailing Address - Phone:614-922-0695
Mailing Address - Fax:
Practice Address - Street 1:793 W STATE ST
Practice Address - Street 2:MT CARMEL WEST
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222
Practice Address - Country:US
Practice Address - Phone:614-234-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN300822163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant