Provider Demographics
NPI:1093240806
Name:MUIR, AMELIA (NP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:MUIR
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 1:58 N 9TH ST OFC 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-2018
Mailing Address - Country:US
Mailing Address - Phone:315-351-2468
Mailing Address - Fax:
Practice Address - Street 1:58 N 9TH ST OFC 6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-2018
Practice Address - Country:US
Practice Address - Phone:315-351-2468
Practice Address - Fax:681-200-8298
Is Sole Proprietor?:No
Enumeration Date:2017-04-30
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402416363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health