Individual
AMANDA STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4704274564
MI
Other
Enumeration date
06/12/2018
Last updated
06/12/2018
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