Individual
AMANDA HERRMANN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
355 W 16TH ST STE 3200, INDIANAPOLIS, IN 46202-2280
(317) 948-5450
(317) 968-1256
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
71013844A
IN
363LP2300X
Primary Care Nurse Practitioner
28212026A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
262210083
MEDICARE PTAN
IN
05
—
300078761
—
IN
Enumeration date
07/18/2022
Last updated
02/14/2025
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