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NPI Code Detail

MEDICARE: AMANDA LARSON

MEDICARE: AMANDA LARSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71011379AIN

General Provider Information

NPI Number : 1538832944
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LARSON
Provider Business Mailing Address
First Line : 8455 KEYSTONE CROSSING SUITE 300
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46240
Country : US
Telephone Number : 317-941-7338
Fax Number : 317-969-6727
Provider Business Practice Location Address
First Line : 302 N JOHNSON RD
Second Line :
City : MOORESVILLE
State : IN
Zip : 46158-5504
Country : US
Telephone Number : 317-941-7338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2021
Last Update Date : 05/06/2026

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Directions to “ AMANDA LARSON ” Practice Location

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