Provider Demographics
NPI:1447749437
Name:BURROW, AMIE (ADVANCED PRACTICE NU)
Entity Type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:
Last Name:BURROW
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NU
Other - Prefix:MS
Other - First Name:AMIE
Other - Middle Name:
Other - Last Name:WILLMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2507
Mailing Address - Country:US
Mailing Address - Phone:315-349-5511
Mailing Address - Fax:
Practice Address - Street 1:110 W 6TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2507
Practice Address - Country:US
Practice Address - Phone:315-349-5511
Practice Address - Fax:315-349-5785
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005408363LF0000X
NYF347243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily