Provider Demographics
NPI:1891270278
Name:BABCOCK, AMANDA NICHOLE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICHOLE
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23260 VAN RESORT DR
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MI
Mailing Address - Zip Code:49072-9596
Mailing Address - Country:US
Mailing Address - Phone:269-858-6943
Mailing Address - Fax:
Practice Address - Street 1:23260 VAN RESORT DR
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MI
Practice Address - Zip Code:49072-9596
Practice Address - Country:US
Practice Address - Phone:269-858-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program