Provider Demographics
NPI:1295146215
Name:DUARTE, AMANDA J (DNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:J
Last Name:DUARTE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:KUULA-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3612 DELL RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842
Mailing Address - Country:US
Mailing Address - Phone:586-612-3732
Mailing Address - Fax:
Practice Address - Street 1:812 E JOLLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-244-8030
Practice Address - Fax:517-244-7183
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704205110363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner