Individual
AMANDA CHAGOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
21415 GODDARD RD, TAYLOR, MI 48180-4247
(734) 375-6900
(734) 398-3737
Mailing address
21415 GODDARD RD, TAYLOR, MI 48180-4247
(734) 375-6900
(734) 398-3737
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704316495
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APRN.CNP.0027419
OH
Other
Enumeration date
08/24/2020
Last updated
10/22/2025
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