Basic Information
| Provider Information | |||||||||
| NPI: | 1477860617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARKAND | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | JUNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 E COUNTY LINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461431072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178852860 | ||||||||
| FaxNumber: | 3178852869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2010 | ||||||||
| LastUpdateDate: | 07/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 71003390A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 28147343A | 01 | IN | INDIANA LICENSE | OTHER | FO710407 | 01 | IN | AANP | OTHER | 200998640 | 05 | IN | MEDICAID |