Doctor Name: | AMY H OLDEJANS |
NPI Number: | 1972687978 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 4704135672 |
Business Practice Address: | 1500 S Main St Eaton Rapids, MI - 488271952 |
Business Phone Number: | 5179994500 |
Business Fax Number: | 5179994510 |
Mailing Address: | 1500 S Main St, EATON RAPIDS |
State: | MI |
Postal Code: | 488271952 |
Phone Number: | 5179994500 |
Fax Number: | 5179994510 |
NPI Enumeration Date: | 10/25/2006 |
NPI Last Update Date: | 02/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704135672 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |