Healthcare Provider Details

I. General information

NPI: 1073093621
Provider Name (Legal Business Name): MRS. AMANDA LEIGH POTCHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LEIGH SIDEBOTTOM

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date: 08/26/2025
Reactivation Date: 10/01/2025

III. Provider practice location address

1490 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4336
US

IV. Provider business mailing address

1490 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4336
US

V. Phone/Fax

Practice location:
  • Phone: 855-407-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704400935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: