Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 201806900600 |
NPI | 1114410404 |
---|---|
Provider Name | Amanda M Netherly |
First Address | Cincinnati, OH 45238-6035 |
Second Address | Cincinnati, OH 45238-6035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201806900600 | GENERAL CONTRACTOR (01) | OH |