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:PO BOX 30161
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-7661
Mailing Address - Country:US
Mailing Address - Phone:517-887-4383
Mailing Address - Fax:517-679-2880
Practice Address - Street 1:1601 E KALAMAZOO ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2701
Practice Address - Country:US
Practice Address - Phone:517-679-2880
Practice Address - Fax:517-679-2883
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704205110363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner