Individual
AMANDA ROEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9669 E 146TH ST STE 100, NOBLESVILLE, IN 46060-5006
(317) 621-3434
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7584
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003631A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10003631A
INDIANA LICENSE NUMBER
IN
Enumeration date
05/27/2022
Last updated
01/31/2023
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