Provider Demographics
NPI:1164146072
Name:ELITE FAMILY NURSE PRACTITIONERS, LLC
Entity Type:Organization
Organization Name:ELITE FAMILY NURSE PRACTITIONERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:DECH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN/FNP-C
Authorized Official - Phone:219-728-6562
Mailing Address - Street 1:407 W INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2350
Mailing Address - Country:US
Mailing Address - Phone:219-728-6562
Mailing Address - Fax:219-728-6564
Practice Address - Street 1:407 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2350
Practice Address - Country:US
Practice Address - Phone:219-728-6562
Practice Address - Fax:219-728-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty