Healthcare Provider Details

I. General information

NPI: 1639825219
Provider Name (Legal Business Name): AMANDA RYAN TROMLEY AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30500 23 MILE RD
CHESTERFIELD MI
48047-1845
US

IV. Provider business mailing address

30500 23 MILE RD
CHESTERFIELD MI
48047-1845
US

V. Phone/Fax

Practice location:
  • Phone: 586-255-5520
  • Fax:
Mailing address:
  • Phone: 586-255-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704305780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: