Provider Demographics
NPI:1669113403
Name:SEABOLT, AMANDA M (PHD, PMHNP-BC, RN)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:SEABOLT
Suffix:
Gender:F
Credentials:PHD, PMHNP-BC, RN
Other - Prefix:
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Mailing Address - Street 1:271 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:OH
Mailing Address - Zip Code:43540-9703
Mailing Address - Country:US
Mailing Address - Phone:419-266-5251
Mailing Address - Fax:419-754-2306
Practice Address - Street 1:7110 W CENTRAL AVE STE E
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-3115
Practice Address - Country:US
Practice Address - Phone:419-266-5251
Practice Address - Fax:419-754-2306
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2025-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0038240363LP0808X
OHRN.393970163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice