Provider Demographics
NPI:1831722511
Name:KULKA, AMANDA BETSY (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETSY
Last Name:KULKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 WATUGA ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-1067
Mailing Address - Country:US
Mailing Address - Phone:248-260-8531
Mailing Address - Fax:
Practice Address - Street 1:3510 MIDDLEBURY LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-4068
Practice Address - Country:US
Practice Address - Phone:248-225-2965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253956163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse