Provider Demographics
NPI:1639874373
Name:GOTTSHALL, AMANDA LYNNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNNE
Last Name:GOTTSHALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 W DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9091
Mailing Address - Country:US
Mailing Address - Phone:814-934-1577
Mailing Address - Fax:
Practice Address - Street 1:591 W DIVISION RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-9091
Practice Address - Country:US
Practice Address - Phone:814-934-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27078148A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty