Provider Demographics
NPI:1538971528
Name:BUCKEL, AMANDA SUE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:BUCKEL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6332 DEERSTAND RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9154
Mailing Address - Country:US
Mailing Address - Phone:317-750-5403
Mailing Address - Fax:
Practice Address - Street 1:134 N EMERSON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9760
Practice Address - Country:US
Practice Address - Phone:317-750-5403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28224263A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant