Active NPI
Amanda Nicole Nelson, COSMETIC THERAPIST
- Other Technician
- Chardon, OH
National Provider Identifier
1992336770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 32019195
- Practice address
- 133 Up Main St
Chardon, OH 44024 - Phone
- (440) 487-8493
- NPI assigned
- Jan 30, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 32019195 | OH | Primary |
Addresses
Primary practice location
133 Up Main St
Chardon, OH 44024
Mailing address
181 Hickory Hill Rd
Painesville, OH 44077-5137
Phone (440) 487-8493
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cosmeticlaser@roadrunner.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32019195 | OH | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580342400000",
"number": "1992336770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "181 HICKORY HILL RD",
"city": "PAINESVILLE",
"state": "OH",
"postal_code": "440775137",
"telephone_number": "440-487-8493"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 UP MAIN ST",
"city": "CHARDON",
"state": "OH",
"postal_code": "44024",
"telephone_number": "440-487-8493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "AMANDA",
"middle_name": "NICOLE",
"name_prefix": "Miss",
"credential": "COSMETIC THERAPIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-30",
"last_updated": "2020-01-30",
"certification_date": "2020-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "OH",
"license": "32019195",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cosmeticlaser@roadrunner.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "133 up Main St",
"city": "Chardon",
"state": "OH",
"country_code": "US",
"postal_code": "44024",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Chardon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.