Provider Demographics
NPI:1487691549
Name:JANSEN, AMY R (CNM)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:JANSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 5 MILE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2189
Mailing Address - Country:US
Mailing Address - Phone:513-559-7175
Mailing Address - Fax:
Practice Address - Street 1:7502 STATE RD STE 4410
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2596
Practice Address - Country:US
Practice Address - Phone:513-599-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.07404367A00000X
IN28140312A367A00000X, 367A00000X
IN72000071A367A00000X
KYNP4325M367A00000X
OH07404367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2535984Medicaid
KY78012853Medicaid
P91716Medicare UPIN
KY3396884Medicare PIN
KY3316384Medicare PIN
KY78012853Medicaid
KY0969482Medicare PIN