Provider Demographics
NPI:1275828469
Name:WESTRICK, AMY MARIE (APRN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:WESTRICK
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:MCL2CRED
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-3146
Mailing Address - Fax:
Practice Address - Street 1:1502 LONDON RD STE 102
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1787
Practice Address - Country:US
Practice Address - Phone:218-576-0100
Practice Address - Fax:218-576-0126
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1566363LF0000X
MNR 161374-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1275828469Medicaid
MN1275828469Medicaid
MN5000083800 EH-VA MEDMedicare PIN