Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 11015970A | IN |
NPI | 1003115650 |
---|---|
Provider Name | Amanda Houchens |
First Address | Detroit, MI 48278-1076 |
Second Address | Carmel, IN 46032-4840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 13/03/2021 |