Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 4704216141 | MI |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 4704216141 | MI |
NPI | 1962595405 |
---|---|
Provider Name | Amanda Jean Barton |
First Address | Cadillac, MI 49601-2588 |
Second Address | Mc Bain, MI 49657-9683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 13/10/2021 |