Provider Demographics
NPI:1356349997
Name:LENDLER, AMANDA (CNM; MSN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LENDLER
Suffix:
Gender:F
Credentials:CNM; MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-3183
Practice Address - Street 1:675 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3153
Practice Address - Country:US
Practice Address - Phone:203-250-2125
Practice Address - Fax:203-250-2161
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00206 LNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
707789OtherCONNECTICARE
CT40CNM0206CT01OtherANTHIM BLUE CROSS OF CT
0Q2712OtherHEALTH NET
P2854778OtherOXFORD HEALTH PLANS
707789OtherCONNECTICARE