Healthcare Provider Details

I. General information

NPI: 1376406769
Provider Name (Legal Business Name): AMANDA NICOLE STANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W SUGNET RD
MIDLAND MI
48640-2647
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-832-0900
  • Fax: 989-633-0349
Mailing address:
  • Phone: 844-632-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704377118
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2025047196
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: