Doctor Name: | MRS. AMANDA LYNN ALLEN |
NPI Number: | 1821453218 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 4704231602 |
Business Practice Address: | 205 S Bradley Hwy Rogers City, MI - 497792137 |
Business Phone Number: | 9894640508 |
Business Fax Number: | |
Mailing Address: | 205 S Bradley Hwy, ROGERS CITY |
State: | MI |
Postal Code: | 497792137 |
Phone Number: | 9894640508 |
Fax Number: | |
NPI Enumeration Date: | 12/29/2015 |
NPI Last Update Date: | 12/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704231602 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |