Individual
AMANDA KAY WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7979 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46250-2042
(317) 621-4300
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28189264A
IN
363L00000X
Nurse Practitioner
Primary
71015476A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300093159
—
IN
Enumeration date
01/23/2024
Last updated
08/08/2024
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