Provider Demographics
NPI:1205025046
Name:ANDERSON, AMORETTE LEANN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMORETTE
Middle Name:LEANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-9203
Mailing Address - Country:US
Mailing Address - Phone:989-275-1200
Mailing Address - Fax:989-275-1210
Practice Address - Street 1:234 LAKE ST
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-9203
Practice Address - Country:US
Practice Address - Phone:989-275-1200
Practice Address - Fax:989-275-1210
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK999OtherSTATE LICENSE
MI4704205103OtherMICHIGAN STATE LICENSE
AKCL1391Medicaid
AK999OtherSTATE LICENSE