Provider Demographics
NPI:1114439312
Name:ROSENBAUM, AMY S (APRN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MUTZNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1302 WALL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3885
Mailing Address - Country:US
Mailing Address - Phone:812-288-4304
Mailing Address - Fax:
Practice Address - Street 1:2219 HOLIDAY MANOR CTR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6463
Practice Address - Country:US
Practice Address - Phone:502-813-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007586A363L00000X, 363LF0000X
KY3011760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner