Provider Demographics
NPI:1194017624
Name:HAYCRAFT, AMY LOUISE (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:HAYCRAFT
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 1:125 THISSEN CT STE 1600
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5578
Mailing Address - Country:US
Mailing Address - Phone:480-206-9477
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:SOUTH CENTRAL HUMAN RELATIONS CENTER
Practice Address - Street 2:610 FLORENCE AVE
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060
Practice Address - Country:US
Practice Address - Phone:507-451-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3999363LA2200X
MN608363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4981882917OtherPECOS