Provider Demographics
NPI:1316385768
Name:DZIKOWICZ, AMY L (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:DZIKOWICZ
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 1:425 CHERRY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4601
Mailing Address - Country:US
Mailing Address - Phone:616-774-7005
Mailing Address - Fax:616-774-0516
Practice Address - Street 1:425 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4601
Practice Address - Country:US
Practice Address - Phone:616-774-7005
Practice Address - Fax:616-774-0516
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704207289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231858Medicare Oscar/Certification