MEDICARE: AMANDA L HARMON APRN, WHNP-BC, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	28164614A	IN
2	363LW0102X	Women's Health Nurse Practitioner	71013997A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093407041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA L HARMON APRN, WHNP-BC, IBCLC

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 E COUNTY LINE RD STE 300
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0990
Country	:	US
Telephone Number	:	317-497-2300
Fax Number	:	317-497-2502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	06/02/2026

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