Individual provider Active NPI

Amanda Nichole Bruhnsen, NP

  • Nurse Practitioner
  • Ann Arbor, MI
National Provider Identifier
1295269355
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704303573 Issued in MI
Practice address
1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone
(734) 936-4000
NPI assigned
Apr 16, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 4704303573 MI
Nurse Practitioner 363L00000X 4704303573 MI Primary

Addresses

Primary practice location

1500 E Medical Center Dr
Ann Arbor, MI 48109-5000

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Other practice location 1

2390 Mitchell Park Dr Ste A
Petoskey, MI 49770-8965
Phone (231) 487-2250

Other practice location 2

740 S Main St Fl 2
Cheboygan, MI 49721-2220
Phone (231) 627-7118

Other identifiers 1

IdentifierTypeStateIssuer
1295269355MedicaidMI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address amanda.bruhnsen.p1@direct.alcona.nextgenshare.com
Direct Messaging Address amanda.bruhnsen.p1@direct.alcona.nextgenshare.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240126000752 MI Practitioner - Nurse Practitioner 2163875113 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704303573MIMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Nurse Practitioner CurrentSince Mar 11, 2025 Accepting new patients
Regents of the University of Michigan CurrentSince Mar 11, 2025 Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

Interoperability endpoints

  • Direct secure messaging: amanda.bruhnsen.p1@direct.alcona.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1492300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1295269355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095000",
            "telephone_number": "734-936-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2390 Mitchell Park Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Petoskey",
            "state": "MI",
            "postal_code": "497708965",
            "country_code": "US",
            "telephone_number": "231-487-2250",
            "fax_number": "231-412-6360",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "740 S Main St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Cheboygan",
            "state": "MI",
            "postal_code": "497212220",
            "country_code": "US",
            "telephone_number": "231-627-7118",
            "fax_number": "231-363-1822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUHNSEN",
        "first_name": "AMANDA",
        "middle_name": "NICHOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-16",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704303573",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704303573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295269355",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amanda.bruhnsen.p1@direct.alcona.nextgenshare.com",
            "affiliation": "N",
            "address_1": "2390 Mitchell Park Dr Ste A",
            "city": "Petoskey",
            "state": "MI",
            "country_code": "US",
            "postal_code": "497708965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amanda.bruhnsen.p1@direct.alcona.nextgenshare.com",
            "affiliation": "N",
            "address_1": "740 S Main St Fl 2",
            "city": "Cheboygan",
            "state": "MI",
            "country_code": "US",
            "postal_code": "497212220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.