Healthcare Provider Details

I. General information

NPI: 1528994845
Provider Name (Legal Business Name): AMANDA ALLISON WHITTREDGE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA ALLISON NEWBERRY

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 HOLLAND AVE
PORT HURON MI
48060-1519
US

IV. Provider business mailing address

1943 HOLLAND AVE
PORT HURON MI
48060-1519
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-5700
  • Fax: 810-985-5454
Mailing address:
  • Phone: 810-985-5700
  • Fax: 810-985-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703131293
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: