Provider Demographics
NPI:1245200856
Name:NTOBURI, AMY L (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:NTOBURI
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4717
Mailing Address - Country:US
Mailing Address - Phone:507-529-6650
Mailing Address - Fax:
Practice Address - Street 1:1650 4TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4717
Practice Address - Country:US
Practice Address - Phone:507-529-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR148305-3363LW0102X
MNCNM 0214367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN526T6LAOtherBCBS MN
44626OtherSIOUX VALLEY HEALTH PLAN
07-04146OtherMEDICA
1042353OtherPREFERRED ONE
132412OtherUCARE
2258974OtherAMERICA'S PPO (ARAZ)
MN969683100Medicaid
HP48176OtherHEALTH PARTNERS
132412OtherUCARE
MN500002782Medicare ID - Type Unspecified