Healthcare Provider Details

I. General information

NPI: 1093433500
Provider Name (Legal Business Name): MRS. AMANDA LEIGH LAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 CADE RD
BROWN CITY MI
48416-9778
US

IV. Provider business mailing address

7115 CADE RD
BROWN CITY MI
48416-9778
US

V. Phone/Fax

Practice location:
  • Phone: 810-346-2757
  • Fax: 810-346-2016
Mailing address:
  • Phone: 810-346-2757
  • Fax: 810-346-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022009770
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: