Provider Demographics
NPI:1073172326
Name:AMOROSE, LEAH KRISTINE (DNP, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:KRISTINE
Last Name:AMOROSE
Suffix:
Gender:F
Credentials:DNP, RN, FNP-BC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KRISTINE
Other - Last Name:SCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12701 TELEGRAPH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4087
Mailing Address - Country:US
Mailing Address - Phone:734-374-0500
Mailing Address - Fax:734-374-2415
Practice Address - Street 1:12701 TELEGRAPH RD STE 103
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4087
Practice Address - Country:US
Practice Address - Phone:734-374-0500
Practice Address - Fax:734-374-2415
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0868833OtherBCBSM PIN
MI1073172326Medicaid