Healthcare Provider Details

I. General information

NPI: 1558747493
Provider Name (Legal Business Name): AMANDA GAHSMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 HANNAH BLVD SUITE 114
EAST LANSING MI
48823-5384
US

IV. Provider business mailing address

2900 HANNAH BLVD SUITE 114
EAST LANSING MI
48823-5384
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-8080
  • Fax: 517-364-8088
Mailing address:
  • Phone: 517-364-8080
  • Fax: 517-364-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704225407
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: