Provider Demographics
NPI:1568414027
Name:HUYCK, AMANDA LYNNE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNNE
Last Name:HUYCK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:LYNNE
Other - Last Name:MIETTINEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, MSNA
Mailing Address - Street 1:3621 SOUTH STATE STREET
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-936-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166853367500000X
MI4704269636367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010269733Medicaid
VA010269733Medicaid