Provider Demographics
NPI:1760134696
Name:KAZA, AMANDA (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KAZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 150036
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49515-0036
Mailing Address - Country:US
Mailing Address - Phone:616-456-9553
Mailing Address - Fax:616-454-5371
Practice Address - Street 1:743 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6045
Practice Address - Country:US
Practice Address - Phone:616-456-8553
Practice Address - Fax:616-454-5371
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2023-05-23
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Provider Licenses
StateLicense IDTaxonomies
MI4704252802363LA2200X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health