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General NPI Number Information
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NPI Number | 1689223877
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Entity Type | Individual
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Provider Name | AMANDA BOUR NP
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 10/19/2025
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Provider Practice Location Address
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Address Line | 30695 LITTLE MACK AVE STE 500
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City | ROSEVILLE
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State | MI
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Zip | 48066-1772
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Country | US
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Telephone | 313-401-0256
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Fax |
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Provider Business Mailing Address
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Address Line | 7179 TURTLE CREEK CT APT 3B
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City | PERRYSBURG
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State | OH
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Zip | 43551-7488
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Country | US
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Telephone | 419-324-9661
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Fax |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704372464
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License Number State | MI
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