Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3003600 | KY |
NPI | 1003837352 |
---|---|
Provider Name | Amy E Fathman |
First Address | Cincinnati, OH 45263-2498 |
Second Address | Taylor Mill, KY 41015-4604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 27/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P39149 | (02) | OH |