Basic Information
| Provider Information | |||||||||
| NPI: | 1952559007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORR | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4943 ROSEBUD LN | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476309226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124714302 | ||||||||
| FaxNumber: | 8124714303 | ||||||||
| Practice Location | |||||||||
| Address1: | 4943 ROSEBUD LN | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476309226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124714302 | ||||||||
| FaxNumber: | 8124714303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 07/18/2012 | ||||||||
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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 | 71002720A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | 71002720A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 115535 | 01 | SIHO | OTHER |