Provider Demographics
NPI:1467004416
Name:SCHAFER, AMELIA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W MICHIGAN AVE APT 2J
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5562
Mailing Address - Country:US
Mailing Address - Phone:616-548-0172
Mailing Address - Fax:
Practice Address - Street 1:901 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-1367
Practice Address - Country:US
Practice Address - Phone:906-486-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704387300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid