Individual
AMANDA S RENNIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1520 S LIBERTY DR, BLOOMINGTON, IN 47403-5167
(812) 676-4300
Mailing address
1520 S LIBERTY DR, BLOOMINGTON, IN 47403-5167
(812) 676-4300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28250897A
IN
363L00000X
Nurse Practitioner
71014562A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71014562A
IN
Other
Enumeration date
10/16/2023
Last updated
11/22/2023
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