Individual
AMANDA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4700 E 13 MILE RD, WARREN, MI 48092-4438
(586) 576-0431
Mailing address
42 W WARREN AVE, DETROIT, MI 48201-1347
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/30/2020
Last updated
09/02/2021
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