Provider Demographics
NPI:1003364894
Name:FARLEY, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 KIMBERLY
Mailing Address - Street 2:APT 201
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2950
Mailing Address - Country:US
Mailing Address - Phone:269-369-6066
Mailing Address - Fax:
Practice Address - Street 1:612 KIMBERLY
Practice Address - Street 2:APT 201
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-2950
Practice Address - Country:US
Practice Address - Phone:269-369-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other