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General NPI Number Information
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NPI Number | 1144115833
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Entity Type | Individual
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Provider Name | AMANDA ROSE YEAZEL
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 808 N 3RD ST
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City | GOSHEN
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State | IN
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Zip | 46528-7100
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Country | US
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Telephone | 574-534-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 123 OAK RD
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City | PLYMOUTH
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State | IN
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Zip | 46563-9751
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Country | US
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Telephone | 574-780-1673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 28251364A
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License Number State | IN
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