Amanda Leigh Potchen

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704400935 Issued in MI

Practice address

1490 E Beltline Ave SE
Grand Rapids, MI 49506-4336

Phone

(855) 407-7575

NPI assigned

Aug 14, 2018

Reactivated

Oct 1, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Amanda Leigh Sidebottom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1073093621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 E BELTLINE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495064336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 E BELTLINE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495064336",
            "telephone_number": "855-407-7575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4112 W St Joe Hwy Ste B",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489174296",
            "country_code": "US",
            "telephone_number": "818-668-1403 x2113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTCHEN",
        "first_name": "AMANDA",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-14",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "deactivation_date": "2025-08-26",
        "reactivation_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704400935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "SIDEBOTTOM",
            "middle_name": "LEIGH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Posthumus Family Dentistry, PC
• David Michael Posthumus, DDS
• Mark William Posthumus, DDS
• Keith Postma, MD
• Richard C. Postma, MD
• Potential LLP PLLC
• Diane Marie Potgeter, PT
• Kristine Ann Pothoven, OTRL
• Thomas Robert Pott, MD
• Dennis Potter, MSW CSW

• Registered Nurse in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.