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General NPI Number Information
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NPI Number | 1760134696
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Entity Type | Individual
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Provider Name | AMANDA KAZA NP
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Gender | Female
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 3210 EAGLE RUN DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7051
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Country | US
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Telephone | 616-456-9553
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Fax | 616-454-5371
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Provider Business Mailing Address
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Address Line | PO BOX 150036
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City | GRAND RAPIDS
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State | MI
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Zip | 49515-0036
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Country | US
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Telephone | 616-456-9553
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Fax | 616-454-5371
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704252802
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4704252802
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License Number State | MI
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