Provider Demographics
NPI:1588928683
Name:SPEER, AMANDA
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:SPEER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-1626
Mailing Address - Country:US
Mailing Address - Phone:440-855-9119
Mailing Address - Fax:
Practice Address - Street 1:796 GROVE ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-1626
Practice Address - Country:US
Practice Address - Phone:440-855-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide