Healthcare Provider Details

I. General information

NPI: 1427326206
Provider Name (Legal Business Name): AMANDA L GARGANO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LEE LAWRENCE

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 N ILLINOIS ST STE 545
CARMEL IN
46032-3014
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-5155
  • Fax: 317-217-2233
Mailing address:
  • Phone: 317-396-1300
  • Fax: 317-962-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003790A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: