Provider Demographics
NPI:1770015596
Name:MICHALS, AMANDA BROOKE (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BROOKE
Last Name:MICHALS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 REGENT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6229
Mailing Address - Country:US
Mailing Address - Phone:877-870-1775
Mailing Address - Fax:614-968-8840
Practice Address - Street 1:4200 REGENT ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6229
Practice Address - Country:US
Practice Address - Phone:877-870-1775
Practice Address - Fax:614-968-8840
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77790363LF0000X
MO2010020495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily