Provider Demographics
NPI:1164084943
Name:MACHEN, AMY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:MACHEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 W SHIELD ST
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-1287
Mailing Address - Country:US
Mailing Address - Phone:509-847-8903
Mailing Address - Fax:
Practice Address - Street 1:25 N 2000 W STE 3
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-4115
Practice Address - Country:US
Practice Address - Phone:435-635-9444
Practice Address - Fax:435-635-8108
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant