MRS. AMANDA ROSE PUNG (NPI# 1699844571) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699844571 |
| Entity Type | Individual |
| Full Name | MRS. AMANDA ROSE PUNG |
| Credential | PA C |
| Practice Address |
319 W Delaware St Decatur MI 49045-1106 |
| Practice Telephone | 2694237028 |
| Practice Fax Number | 2694238282 |
| Mailing Telephone | 2694237028 |
| Mailing Fax Number | 2694238282 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-10-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
5601004946 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS | 5390069 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225506637 | Amanda Pung | Behavior Technician | 650 W Grand Ave Ste 150, Elmhurst, IL 60126-1043 | 2018-11-05 |
| Street Address |
319 W DELAWARE ST |
| City | DECATUR |
| State | MI |
| Zip Code | 49045-1106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639166747 | Lester Burkow | Family Medicine | 319 W Delaware St, Decatur, MI 49045-1106 | 2005-10-04 |
| 1649886607 | Melissa Lynn Williams | Social Worker | 319 W Delaware St, Decatur, MI 49045-1106 | 2020-09-16 |
| 1245869585 | Erica Nagra | Registered Nurse | 319 W Delaware St, Decatur, MI 49045-1106 | 2020-04-08 |
| 1376767285 | Bronson Lakeview Hospital | Family Medicine | 319 W Delaware St, Decatur, MI 49045-1106 | 2007-04-12 |
| 1942373089 | Song Yol Yu | Family Medicine | 319 W Delaware St, Decatur, MI 49045-1106 | 2006-11-16 |
| 1306815550 | David Joseph Wendling | Family Medicine | 319 W Delaware St, Decatur, MI 49045-1106 | 2006-03-17 |
| 1861462996 | Connie L Harris | Nurse Practitioner | 319 W Delaware St, Decatur, MI 49045-1106 | 2006-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508106121 | Murks Village Market Inc | Pharmacy | 108b East Delaware Street, Decatur, MI 49045 | 2013-02-19 |
| 1295863066 | Linda Arlene Berrington | Pharmacist | 108 B E Delaware St, Decatur, MI 49045 | 2007-03-01 |
| 1891228342 | Jorge Ricardo Swett Tapia | Dentist | 321 W Delaware St, Decatur, MI 49045 | 2017-04-11 |
| 1295741320 | Dale Eugene Bryant Jr. | Registered Nurse | 216 E Saint Marys St, Decatur, MI 49045-1023 | 2006-07-31 |
| 1023133378 | Robert Steven Murav | Dentist | 321 W Delaware St, Decatur, MI 49045-1106 | 2007-03-19 |
| 1255495685 | Richard Lewis Moussalli | Dentist | 115 S Phelps St, Decatur, MI 49045-1117 | 2006-12-20 |
| 1285645796 | Decatur Pharmacy | Durable Medical Equipment & Medical Supplies | 100 W Sherwood St, Decatur, MI 49045-1120 | 2006-08-10 |
| 1396150546 | Blue Seahorse Inc. | Counselor | 101 E Delaware St, Decatur, MI 49045-1131 | 2014-06-26 |
| 1407491277 | Twin Doves II LLC | Community Based Residential Treatment Facility, Mental Illness | 40739 80th Ave, Decatur, MI 49045-8158 | 2019-11-15 |
| 1467888123 | Kristin Lee Desrosiers | Social Worker | 79315 County Road 681, Decatur, MI 49045-9023 | 2013-09-25 |
| Find all providers in zip 49045 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891136750 | Rodney Oneal Morrison | Physician Assistant | 3204 Jefferson Square Ct, Decatur, GA 30030-1730 | 2013-07-08 |
| 1558625319 | Coraccess, Inc | Physician Assistant | 1478 Leafview Rd, Decatur, GA 30033-2112 | 2012-06-26 |
| 1326525437 | Aopa, LLC | Physician Assistant | 2801 N Decatur Rd Ste 200, Decatur, GA 30033-5936 | 2018-07-21 |
| 1104274323 | Monal, LLC | Physician Assistant | 1014 Sycamore Dr, Suite B, Decatur, GA 30030-1644 | 2016-05-27 |
| 1235505280 | Moniqua Turner | Physician Assistant | 2675 N Decatur Rd, Decatur, GA 30033-6131 | 2015-08-13 |
| 1982093480 | Southeastern Orthopedic Surgical Pa, LLC | Physician Assistant | 2801 N Decatur Rd, Suite 200, Decatur, GA 30033-5949 | 2015-01-21 |
| 1861768467 | Lindsay Contracting Services | Physician Assistant | 2801 N Decatur Rd Ste 200, Decatur, GA 30033-5936 | 2012-03-28 |
| 1740560978 | Midwestern Advanced Orthopaedics and Sports Medicine Inc | Physician Assistant | 2801 N Decatur Rd, Suite 200, Decatur, GA 30033-5949 | 2011-08-19 |
| 1114169703 | Edg Sports Medicine,inc | Physician Assistant | 2801 N Decatur Rd, Suite 200, Decatur, GA 30033-5949 | 2009-03-30 |
| 1114110061 | Douglas T. Johnson | Physician Assistant | 2801 N Decatur Rd Ste 200, Decatur, GA 30033-5936 | 2007-08-23 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.