Provider Demographics
NPI:1447651005
Name:DENEAL, AMY JO (NP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:DENEAL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8239 STONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-5011
Mailing Address - Country:US
Mailing Address - Phone:317-213-9224
Mailing Address - Fax:
Practice Address - Street 1:400 N MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-9497
Practice Address - Country:US
Practice Address - Phone:765-335-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28177343A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner