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Individual

AMANDA LYNN LOOSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BS, QIDP, QMHP

Contact information

Practice address
511 GRIFFIN RD, WEST BRANCH, MI 48661-9251
(989) 345-5571
Mailing address
401 KELLY ST UNIT B, PRUDENVILLE, MI 48651-2530
(989) 859-2790

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary

Other

Enumeration date
03/30/2021
Last updated
03/30/2021
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