Individual
AMY J FILLMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
13069 STAFFORD RD, LEESBURG, OH 45135-9465
(937) 780-6302
Mailing address
13069 STAFFORD RD, LEESBURG, OH 45135-9465
(937) 780-6302
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.112645
OH
Other
Enumeration date
11/30/2011
Last updated
11/30/2011
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