Basic Information
| Provider Information | |||||||||
| NPI: | 1306299243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POORMAN | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 COSHOCTON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430501440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403939000 | ||||||||
| FaxNumber: | 7403920167 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 COSHOCTON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430501440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403939000 | ||||||||
| FaxNumber: | 7403920167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | RN292038 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | APRN.CNM.019301 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.