Individual
AMANDA RAE AXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 MILITARY ST, PORT HURON, MI 48060-5416
(810) 985-5437
(180) 024-8156
Mailing address
10698 METCALF RD, BROCKWAY, MI 48097-4511
(810) 304-1114
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
372600000X
ADULT COMPANION
MI
Enumeration date
02/14/2013
Last updated
02/14/2013
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