Provider Demographics
NPI:1336977503
Name:ZURAWSKI, AMANDA JEAN (LDH, OMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:ZURAWSKI
Suffix:
Gender:F
Credentials:LDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-4525
Mailing Address - Country:US
Mailing Address - Phone:574-850-6363
Mailing Address - Fax:
Practice Address - Street 1:1006 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-4525
Practice Address - Country:US
Practice Address - Phone:574-850-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IN13007193A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No174400000XOther Service ProvidersSpecialist