Provider Demographics
NPI:1114631884
Name:AMADOR, JENNIFER K (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:AMADOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1351 RONALD REAGAN PKWY STE B
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6764
Practice Address - Country:US
Practice Address - Phone:317-948-3200
Practice Address - Fax:317-217-2424
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28204786A363LF0000X
IN71013476A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300072333Medicaid
IN068010889OtherMEDICARE