Individual
AMANDA M HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11108 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1730
(260) 266-5700
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28219839A
IN
363L00000X
Nurse Practitioner
Primary
71007829A
IN
Other
Enumeration date
12/27/2017
Last updated
12/05/2022
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