Provider Demographics
NPI:1093705865
Name:WALCHENBACH, AMY ANN (ARNP, CFNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ANN
Last Name:WALCHENBACH
Suffix:
Gender:F
Credentials:ARNP, CFNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ANN
Other - Last Name:EMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 SE CABOT DR STE B101
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3740
Mailing Address - Country:US
Mailing Address - Phone:360-675-6648
Mailing Address - Fax:360-679-9310
Practice Address - Street 1:275 SE CABOT DR STE B101
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3740
Practice Address - Country:US
Practice Address - Phone:360-675-6648
Practice Address - Fax:360-679-9310
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61209858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010240930Medicaid
WAAP61209858OtherWA LICENSE
VA009098L19Medicare PIN