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NPI Code Detail

MEDICARE: AMANDA LEE NEILSON NP

MEDICARE: AMANDA LEE NEILSON NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner4704357533MI

General Provider Information

NPI Number : 1376411025
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LEE NEILSON NP
Provider Business Mailing Address
First Line : 2799 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-2608
Country : US
Telephone Number : 580-304-3516
Fax Number :
Provider Business Practice Location Address
First Line : 2799 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-2689
Country : US
Telephone Number : 313-916-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2025
Last Update Date : 02/03/2026

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