Individual
AMANDA L GILLENWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
2159 DOGWOOD RIDGE RD, WHEELERSBURG, OH 45694-9044
(731) 394-1145
Mailing address
36 PEMBERTON CV, JACKSON, TN 38305-5514
(731) 394-1145
(844) 374-0233
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.454549
OH
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN.CNP.0027743
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0331807
—
OH
Enumeration date
01/16/2019
Last updated
10/16/2020
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