Provider Demographics
NPI:1982984183
Name:OSTERGAARD, AMANDA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:OSTERGAARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 73RD STREET
Mailing Address - Street 2:SUITE 33
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1026
Mailing Address - Country:US
Mailing Address - Phone:515-223-4146
Mailing Address - Fax:515-223-1172
Practice Address - Street 1:974 73RD STREET
Practice Address - Street 2:SUITE 33
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1026
Practice Address - Country:US
Practice Address - Phone:515-223-4146
Practice Address - Fax:515-223-1172
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC-114865363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
M02429012OtherDEA