Healthcare Provider Details

I. General information

NPI: 1093407041
Provider Name (Legal Business Name): AMANDA L HARMON APRN, WHNP-BC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E COUNTY LINE RD STE 300
INDIANAPOLIS IN
46227-0990
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-2300
  • Fax: 317-497-2502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number28164614A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71013997A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: