Provider Demographics
NPI:1114530789
Name:BURTON, AMANDA LEE
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEE
Last Name:BURTON
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 1:104 1/2 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3881
Mailing Address - Country:US
Mailing Address - Phone:989-482-9331
Mailing Address - Fax:
Practice Address - Street 1:104 1/2 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3881
Practice Address - Country:US
Practice Address - Phone:989-482-9331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician