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General NPI Number Information
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NPI Number | 1184237885
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Entity Type | Individual
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Provider Name | AMANDA CHAGOLLA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 21415 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-4247
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Country | US
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Telephone | 734-375-6900
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Fax | 734-398-3737
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Provider Business Mailing Address
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Address Line | 21415 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-4247
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Country | US
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Telephone | 734-375-6900
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Fax | 734-398-3737
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0027419
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704316495
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License Number State | MI
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