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Provider Information for 1518335124

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

AMANDA M GOMEZ NP

Gender: FEMALE

Individual NPI: 1518335124

Calendar   Last Updated:  2021-01-27
  Certification Date:  2021-01-27

Details

Name Value
NPI 1518335124
Enumeration Date 2015-09-14
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 250 N SHADELAND AVE STE 200
INDIANAPOLIS, IN 46219-4959
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 1701 N SENATE BLVD
INDIANAPOLIS, IN 46202-1239
United States

Phone: 317-944-5000 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Direct Messaging Address agomez@direct.iuhealth.org 1701 N SENATE BLVD
INDIANAPOLIS, IN 46202-1239
United States
Other Identifiers
Issuer State Number
MEDICAID IN 201330310
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family IN 71005658A
No 363LA2200X - Nurse Practitioner Adult Health IN 71005658A
No 363LG0600X - Nurse Practitioner Gerontology IN 71005658A
No 363LP2300X - Nurse Practitioner Primary Care IN 71005658A