Provider Demographics
NPI:1407517774
Name:DURST, AMANDA G (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:DURST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8162 CORINTH COURT RD
Mailing Address - Street 2:
Mailing Address - City:FARMDALE
Mailing Address - State:OH
Mailing Address - Zip Code:44417-9745
Mailing Address - Country:US
Mailing Address - Phone:330-240-6071
Mailing Address - Fax:
Practice Address - Street 1:7119 STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:KINSMAN
Practice Address - State:OH
Practice Address - Zip Code:44428-9788
Practice Address - Country:US
Practice Address - Phone:330-876-2803
Practice Address - Fax:330-876-2813
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3325750163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH3325750OtherLICENSED SCHOOL NURSE