Healthcare Provider Details

I. General information

NPI: 1558783019
Provider Name (Legal Business Name): AMANDA LEE NAKASHIAN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CALUMET AVE
DYER IN
46311-1596
US

IV. Provider business mailing address

1001 CALUMET AVE
DYER IN
46311-1596
US

V. Phone/Fax

Practice location:
  • Phone: 219-924-8178
  • Fax:
Mailing address:
  • Phone: 219-864-2086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP5153
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71004787A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.414081
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209010936
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: