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General NPI Number Information
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NPI Number | 1932860632
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Entity Type | Organization
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Legal Business Name | AMANDA REGESTER PEDIATRIC HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 04/02/2022
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Provider Practice Location Address
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Address Line | 654 S WALKER ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2159
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Country | US
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Telephone | 812-369-4344
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 S ANDREW CIR
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City | BLOOMINGTON
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State | IN
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Zip | 47401-7147
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Country | US
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Telephone | 317-450-8498
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Fax |
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Authorized Official
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Title or Position | SOLE-MEMBER
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Name | AMANDA REGESTER
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Credential | PNP
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Telephone | 317-450-8498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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