Provider Demographics
NPI:1760041941
Name:MUNNICH, AMANDA BRITTNEY (CRNA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BRITTNEY
Last Name:MUNNICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 191ST PL
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3713
Mailing Address - Country:US
Mailing Address - Phone:708-428-3857
Mailing Address - Fax:
Practice Address - Street 1:3033 191ST PL
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3713
Practice Address - Country:US
Practice Address - Phone:708-428-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28184663A163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse