Organization · NPI-2

Amanda Regester Pediatric Health Services, LLC

Nurse Practitioner, Pediatrics · Bloomington, IN

NPI number1932860632
StatusActive
Last updated in NPPESApr 2, 2022

Details

NPI
1932860632
Entity type
Organization (NPI-2)
Legal business name
Amanda Regester Pediatric Health Services, LLC
Organization subpart
No
Enumeration date
Jan 4, 2022
Certification date
Apr 2, 2022
Last updated
Apr 2, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, Pediatrics––Yes

Practice location

654 S Walker St
Bloomington, IN 47403-2159

Phone 812-369-4344

Mailing address

1535 S Andrew Cir
Bloomington, IN 47401-7147

Phone 317-450-8498

Authorized official

Amanda Regester
Sole-Member
3174508498

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