Healthcare Provider Details

I. General information

NPI: 1043702335
Provider Name (Legal Business Name): AMANDA ARNOLD CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 MALL DR
PORTAGE MI
49024-2878
US

IV. Provider business mailing address

670 MALL DR
PORTAGE MI
49024-2878
US

V. Phone/Fax

Practice location:
  • Phone: 269-350-8434
  • Fax: 269-350-8435
Mailing address:
  • Phone: 269-350-8434
  • Fax: 269-350-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704340093
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: