Individual
AMANDA VAGELATOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2250 173RD ST, HAMMOND, IN 46323-2074
(765) 494-0111
Mailing address
2250 173RD ST, HAMMOND, IN 46323-2074
(765) 494-0111
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28189650A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201214860
—
IN
01
—
71004816A
APRN - INDIANA
IN
Enumeration date
01/29/2014
Last updated
10/02/2023
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