Provider Demographics
NPI:1497749949
Name:MATERNOWSKI, AMY G (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:G
Last Name:MATERNOWSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0647
Mailing Address - Country:US
Mailing Address - Phone:270-887-4160
Mailing Address - Fax:270-887-4165
Practice Address - Street 1:1700 CANTON ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1923
Practice Address - Country:US
Practice Address - Phone:270-887-4160
Practice Address - Fax:270-887-4165
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2067P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health