Provider Demographics
NPI:1316421423
Name:RAYFORD, AMANDA NICHELL
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICHELL
Last Name:RAYFORD
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 1:498 BIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-2010
Mailing Address - Country:US
Mailing Address - Phone:734-560-9119
Mailing Address - Fax:
Practice Address - Street 1:48880 WEAR RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-9352
Practice Address - Country:US
Practice Address - Phone:734-461-1968
Practice Address - Fax:734-270-2627
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820338256374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty