Provider Demographics
NPI:1801803655
Name:BROWNSBERGER, AMANDA ERIN (CNM)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ERIN
Last Name:BROWNSBERGER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:ERIN
Other - Last Name:DEFEVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:5 LAKESIDE CT
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1906
Mailing Address - Country:US
Mailing Address - Phone:773-802-3028
Mailing Address - Fax:
Practice Address - Street 1:4727 SAINT ANTOINE ST STE 304
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1461
Practice Address - Country:US
Practice Address - Phone:313-745-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL064811367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife