Healthcare Provider Details

I. General information

NPI: 1316517782
Provider Name (Legal Business Name): AMANDA MARIE HUFF DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD
ELKHART IN
46514-2483
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-524-8130
  • Fax: 574-524-8138
Mailing address:
  • Phone: 574-647-6592
  • Fax: 574-647-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28209436A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: