| Doctor Name: | MS. AMANDA CATHERINE JANISSE |
| NPI Number: | 1942561964 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | 4704217937 |
| Business Practice Address: | 2585 W Houghton Lake Dr Prudenville, MI - 486519624 |
| Business Phone Number: | 9893662900 |
| Business Fax Number: | |
| Mailing Address: | 3779 Momentum Pl, CHICAGO |
| State: | IL |
| Postal Code: | 606895337 |
| Phone Number: | 9893662900 |
| Fax Number: | |
| NPI Enumeration Date: | 06/06/2012 |
| NPI Last Update Date: | 01/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704217937 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |