Provider Demographics
NPI:1346817087
Name:RICHIE, AMANDA JO (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:RICHIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E BEARDSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3574
Mailing Address - Country:US
Mailing Address - Phone:574-206-0086
Mailing Address - Fax:574-970-0604
Practice Address - Street 1:1201 E BEARDSLEY AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3574
Practice Address - Country:US
Practice Address - Phone:574-206-0086
Practice Address - Fax:574-970-0604
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28235637A364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care