Provider Demographics
NPI:1144745944
Name:BELCHER, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BELCHER
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:CLARKLAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49234-0026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 GOLDSMITH DR
Practice Address - Street 2:
Practice Address - City:CLARKLAKE
Practice Address - State:MI
Practice Address - Zip Code:49234-5705
Practice Address - Country:US
Practice Address - Phone:517-529-3109
Practice Address - Fax:517-529-3109
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health