Provider Demographics
NPI:1558327049
Name:HACKMAN, AMY M (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:HACKMAN
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 1:1555 E CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1993
Mailing Address - Country:US
Mailing Address - Phone:269-651-7114
Mailing Address - Fax:
Practice Address - Street 1:1555 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1993
Practice Address - Country:US
Practice Address - Phone:269-651-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704176353363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN90090002Medicare ID - Type Unspecified
0M83740Medicare UPIN