MEDICARE: AMANDA KATE WALTRIP 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
1	363L00000X	Nurse Practitioner	4704181802	MI

General Provider Information

NPI Number	:	1639676919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KATE WALTRIP NP

Provider Business Mailing Address
First Line	:	1 HURLEY PLZ
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-5902
Country	:	US
Telephone Number	:	810-262-9953
Fax Number	:	810-262-9483

Provider Business Practice Location Address
First Line	:	300 E 1ST ST STE 201
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502-1900
Country	:	US
Telephone Number	:	810-262-9773
Fax Number	:	810-262-7308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	04/12/2018

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