Provider Demographics
NPI:1003288457
Name:ALTAMASH, AMY (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ALTAMASH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7443 JACKMAN RD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9223
Mailing Address - Country:US
Mailing Address - Phone:734-850-0100
Mailing Address - Fax:734-850-0112
Practice Address - Street 1:7443 JACKMAN RD
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-9223
Practice Address - Country:US
Practice Address - Phone:734-850-0100
Practice Address - Fax:734-850-0112
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704316352363LF0000X
OH361679163W00000X
VA0001241905163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse