Healthcare Provider Details

I. General information

NPI: 1497360580
Provider Name (Legal Business Name): AMANDA BUTCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 FASHION SQUARE BLVD STE L-1
SAGINAW MI
48604-2620
US

IV. Provider business mailing address

801 ROSEHILL RD
JACKSON MI
49202-1762
US

V. Phone/Fax

Practice location:
  • Phone: 989-282-4003
  • Fax: 888-491-7220
Mailing address:
  • Phone: 517-212-2008
  • Fax: 517-212-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704312455
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: