Healthcare Provider Details

I. General information

NPI: 1699886135
Provider Name (Legal Business Name): AUGUSTINA CHIOMA AMADI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PETERBORO STREET
DETROIT MI
48201
US

IV. Provider business mailing address

10 PETERBORO ST
DETROIT MI
48201-2722
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-3160
  • Fax: 313-309-1090
Mailing address:
  • Phone: 313-831-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704229170
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704229170
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704229170
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: