Individual
AMANDA MARIE ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
6505 CHERRY MEADOW DR SE, CALEDONIA, MI 49316-9484
(616) 891-8770
(616) 891-3504
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704318995
MI
Other
Enumeration date
11/14/2021
Last updated
03/18/2026
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