Provider Demographics
NPI:1972024545
Name:SEALOCK, AMANDA JO (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:SEALOCK
Suffix:
Gender:F
Credentials:RN
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5727 CLAY PIKE RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 S 15TH ST STE 206
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1875
Practice Address - Country:US
Practice Address - Phone:740-622-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022208363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology