Provider Demographics
NPI:1497308852
Name:BARRIE, AMANDA ROSE (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:BARRIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ROSE
Other - Last Name:MATTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2810 DUPONT COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2393
Mailing Address - Country:US
Mailing Address - Phone:260-490-7337
Mailing Address - Fax:260-489-8937
Practice Address - Street 1:2810 DUPONT COMMERCE CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2393
Practice Address - Country:US
Practice Address - Phone:260-490-7337
Practice Address - Fax:260-489-8937
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009156A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily