Provider Demographics
NPI:1124774724
Name:STOLARZ, AMANDA (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STOLARZ
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ALBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP-C
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:193-927-0842
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:13963 MORSE ST
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303-9639
Practice Address - Country:US
Practice Address - Phone:219-374-5555
Practice Address - Fax:219-374-6669
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012330A363LF0000X
IN28222790A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily