Healthcare Provider Details

I. General information

NPI: 1093231870
Provider Name (Legal Business Name): AMANDA BROOKE ARISS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9099 E LANSING RD STE B
DURAND MI
48429-1083
US

IV. Provider business mailing address

9099 E LANSING RD STE B
DURAND MI
48429-1083
US

V. Phone/Fax

Practice location:
  • Phone: 989-288-0400
  • Fax: 989-288-7862
Mailing address:
  • Phone: 989-288-0400
  • Fax: 989-288-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704250060
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704250060
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: