Provider Demographics
NPI:1104222850
Name:DIFATTA, AMY MICHELLE (CNA,BA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:DIFATTA
Suffix:
Gender:F
Credentials:CNA,BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10198 HIGHWAY D
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-4169
Mailing Address - Country:US
Mailing Address - Phone:660-676-8756
Mailing Address - Fax:660-337-6682
Practice Address - Street 1:10198 HIGHWAY D
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-4169
Practice Address - Country:US
Practice Address - Phone:660-676-8756
Practice Address - Fax:660-337-6682
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO465327627163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health