Individual
AMANDA CAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684
(231) 935-6250
Mailing address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-5000
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
1-115133
AL
363LN0000X
Neonatal Nurse Practitioner
Primary
904262
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00102370
—
MS
Enumeration date
09/04/2015
Last updated
10/31/2019
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