Basic Information
| Provider Information | |||||||||
| NPI: | 1437349610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TREON | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 SYMMES RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450141844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138934107 | ||||||||
| FaxNumber: | 5138633053 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 SYMMES RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450141844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138934107 | ||||||||
| FaxNumber: | 5138633053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | COA.12564-NM | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LX0001X | COA.12564-NM | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2991062 | 05 | OH | MEDICAID |