Provider Demographics
NPI:1235399353
Name:RATHJE, AMY MARIE (CNNP, MSN, RNC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIE
Last Name:RATHJE
Suffix:
Gender:F
Credentials:CNNP, MSN, RNC
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Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:8TH FLOOR C.S. MOTT CHILDRENS HOSPITAL
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-763-4109
Practice Address - Fax:734-763-7728
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2013-04-29
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Provider Licenses
StateLicense IDTaxonomies
MI4704231736363L00000X
MIL1226250363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal