Healthcare Provider Details

I. General information

NPI: 1285140285
Provider Name (Legal Business Name): AMANDA D HOFMEISTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA D ELLER

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 812-355-6900
  • Fax: 812-355-3270
Mailing address:
  • Phone: 317-963-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28160624A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71007729A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007729A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: