| Doctor Name: | MRS. AMY L WALWORTH |
| NPI Number: | 1164857371 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | COA.14968NP |
| Business Practice Address: | 450b Washington Jackson Rd Suite 105 Eaton, OH - 453207600 |
| Business Phone Number: | 9374568350 |
| Business Fax Number: | 9374568351 |
| Mailing Address: | 450b Washington Jackson Rd, Suite 105 EATON |
| State: | OH |
| Postal Code: | 453207600 |
| Phone Number: | 9374568350 |
| Fax Number: | 9374568351 |
| NPI Enumeration Date: | 09/06/2013 |
| NPI Last Update Date: | 08/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | COA.14968NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |