MEDICARE: AMANDA MARIE BOYD RN

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
1	163WC0400X	Case Management Registered Nurse	28193383A	IN
2	163WD0400X	Diabetes Educator Registered Nurse	28193383A	IN
3	163WP0808X	Psychiatric/Mental Health Registered Nurse	28193383A	IN
4	163WC1500X	Community Health Registered Nurse	28193383A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28193383A	OTHER	IN	RN LICENSE

General Provider Information

NPI Number	:	1558842369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE BOYD RN

Provider Business Mailing Address
First Line	:	23 N RURAL ST APT 101
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3279
Country	:	US
Telephone Number	:	317-412-7420
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 N RURAL ST APT 101
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3279
Country	:	US
Telephone Number	:	317-412-7420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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