Healthcare Provider Details

I. General information

NPI: 1972419547
Provider Name (Legal Business Name): AMANDA CAROL MULKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W CRAPO ST
ALPENA MI
49707-3528
US

IV. Provider business mailing address

102 W CRAPO ST
ALPENA MI
49707-3528
US

V. Phone/Fax

Practice location:
  • Phone: 989-255-5566
  • Fax:
Mailing address:
  • Phone: 989-255-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: