Individual
AMANDA DEHNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 SALEM ST, LAFAYETTE, IN 47904-2164
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28175605A
IN
363LF0000X
Family Nurse Practitioner
Primary
71006337A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001024743
ANTHEM PROVIDER NUMBER UNDER TIN 35-2030653
IN
05
—
201367720
—
IN
Enumeration date
05/06/2016
Last updated
03/29/2017
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