Healthcare Provider Details

I. General information

NPI: 1760151518
Provider Name (Legal Business Name): AMANDA M CARPENTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1896
US

IV. Provider business mailing address

13225 WATERCREST DR
DEWITT MI
48820-8501
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-6801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number4704257040
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: