Provider Demographics
NPI:1780449603
Name:GJERDE, AMANDA P (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:P
Last Name:GJERDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1002 WISHARD BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4164
Mailing Address - Country:US
Mailing Address - Phone:317-944-3966
Mailing Address - Fax:317-968-1354
Practice Address - Street 1:1002 WISHARD BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4164
Practice Address - Country:US
Practice Address - Phone:317-944-3966
Practice Address - Fax:317-968-1354
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71014956A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics