Healthcare Provider Details

I. General information

NPI: 1295146215
Provider Name (Legal Business Name): AMANDA J DUARTE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA J KUULA-JOHNSON NP

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E KALAMAZOO ST
LANSING MI
48912-2701
US

IV. Provider business mailing address

PO BOX 30161
LANSING MI
48909-7661
US

V. Phone/Fax

Practice location:
  • Phone: 517-679-2880
  • Fax: 517-679-2883
Mailing address:
  • Phone: 517-887-4383
  • Fax: 517-679-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704205110
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: