Individual
AMANDA FALLDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1843 W MAIN ST, TROY, OH 45373
(937) 208-4120
(937) 208-4126
Mailing address
3170 KETTERING BLVD BLDG B3, MORAINE, OH 45439-1924
(937) 991-3186
(937) 223-9811
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN.CNP.020035
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0192480
—
OH
Enumeration date
09/06/2016
Last updated
03/24/2020
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