Provider Demographics
NPI:1457448920
Name:WESTCOMB, AMY G (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:G
Last Name:WESTCOMB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:GAIL
Other - Last Name:VANDERSTAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2864 ASHMUN ST
Mailing Address - Street 2:SAULT TRIBAL HEALTH CENTER
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783
Mailing Address - Country:US
Mailing Address - Phone:906-632-5272
Mailing Address - Fax:906-632-5276
Practice Address - Street 1:622 W SUPERIOR ST
Practice Address - Street 2:MUNISING TRIBAL HEALTH CENTER
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1329
Practice Address - Country:US
Practice Address - Phone:906-387-4721
Practice Address - Fax:906-387-4727
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant