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NPI Code Detail

MEDICARE: AMANDA GRAHAM FNP

MEDICARE: AMANDA GRAHAM FNP
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
1363L00000XNurse Practitioner4704260551MI

General Provider Information

NPI Number : 1447500137
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA GRAHAM FNP
Provider Business Mailing Address
First Line : 501 LAPEER AVE
Second Line :
City : SAGINAW
State : MI
Zip : 48607-1208
Country : US
Telephone Number : 989-759-6464
Fax Number : 989-399-8233
Provider Business Practice Location Address
First Line : 6297 DIXIE HWY
Second Line :
City : BRIDGEPORT
State : MI
Zip : 48722-9635
Country : US
Telephone Number : 989-759-6460
Fax Number : 989-759-6465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2012
Last Update Date : 04/08/2021

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