Provider Demographics
NPI:1083359889
Name:TER DOEST, AMANDA LAUREN (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LAUREN
Last Name:TER DOEST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 N COLUMBUS ST STE 260
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8100
Mailing Address - Country:US
Mailing Address - Phone:740-687-8397
Mailing Address - Fax:740-654-4103
Practice Address - Street 1:2405 N COLUMBUS ST STE 260
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8100
Practice Address - Country:US
Practice Address - Phone:740-687-8397
Practice Address - Fax:740-654-4103
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program