Individual
AMANDA DANIELLE GREENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
116 W MITCHELL ST, PETOSKEY, MI 49770-2357
(231) 347-7395
Mailing address
2111 FANTASY LN, MIDLAND, MI 48642-7407
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601009649
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/14/2018
Last updated
08/24/2022
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