Healthcare Provider Details

I. General information

NPI: 1003525924
Provider Name (Legal Business Name): AMANDA RECKERS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 S 15TH ST
RICHMOND IN
47374-6424
US

IV. Provider business mailing address

PO BOX 125
RICHMOND IN
47375-0125
US

V. Phone/Fax

Practice location:
  • Phone: 765-896-4486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0101634
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: