Individual
AMANDA J HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1096 S BELSAY RD STE A, BURTON, MI 48509-1948
(810) 742-6100
Mailing address
7433 STONEVALLEY BLF, CLARKSTON, MI 48348-4375
(304) 617-5424
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
RN.426870
OH
363L00000X
Nurse Practitioner
Primary
4704361205
MI
Other
Enumeration date
08/13/2018
Last updated
01/28/2021
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