AMANDA M LEISURE

FORT WAYNE, IN
NPI1154872653
Former NameAMANDA M WAGNER
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LP0200X Nurse Practitioner, Pediatrics
(Licence: IN  71006767)
Enumeration Date2016-10-19
Last Update Date2022-10-10
Business Address
Miss AMANDA M LEISURE CPNP-AC/PC
11141 PARKVIEW PLAZA DR STE 210
FORT WAYNE, IN 46845-1714
Phone number: 260-266-5400
Mailing Address
Miss AMANDA M LEISURE CPNP-AC/PC
11109 PARKVIEW PLAZA DR # 117
FORT WAYNE, IN 46845-1701
Phone number:
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