Basic Information
| Provider Information | |||||||||
| NPI: | 1639676919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALTRIP | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | KATE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HURLEY PLZ | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485035902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102629953 | ||||||||
| FaxNumber: | 8102629483 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 E 1ST ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485021900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102629773 | ||||||||
| FaxNumber: | 8102627308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704181802 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.