Individual
AMANDA NICOLE MICHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2291 W MARCH LN STE C101, STOCKTON, CA 95207-6669
(209) 817-2668
Mailing address
2291 W MARCH LN STE C101, STOCKTON, CA 95207-6669
(209) 817-2668
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
10/25/2019
Last updated
10/25/2019
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