Amanda Petrusma
Individual provider Active NPI Registered Nurse · Belmont, MI
NPI 1972255669 · NPPES record last updated Jan 24, 2022
Key facts
- NPI
- 1972255669
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 4704276837 (MI)
- Practice address
- 6081 West River Dr NE
Belmont, MI 49306-9219 - Phone
- (616) 625-0386
- NPI assigned
- Jan 24, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704276837 | MI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704276837 | MI | Yes |
Addresses
Primary practice location
6081 West River Dr NE
Belmont, MI 49306-9219
Mailing address
6081 West River Dr NE
Belmont, MI 49306-9219
Phone (616) 625-0386
Other providers in Belmont, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.