1689192809 NPI number — AMY J CODE FNP

Table of content: AMY J CODE FNP (NPI 1689192809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689192809 NPI number — AMY J CODE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CODE
Provider First Name:
AMY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DZIESINSKI
Provider Other First Name:
AMY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689192809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 427
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLMAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49746-0427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-354-2197
Provider Business Mailing Address Fax Number:
989-354-1952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11899 M 32
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49709-9374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-785-4855
Provider Business Practice Location Address Fax Number:
989-785-2267
Provider Enumeration Date:
09/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4704311064 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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