Provider Demographics
NPI:1558377093
Name:GUMPRECHT, AMY-LYN (PA)
Entity Type:Individual
Prefix:
First Name:AMY-LYN
Middle Name:
Last Name:GUMPRECHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 CONWAY ST
Mailing Address - Street 2:GREENFIELD HEALTH CENTER
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301
Mailing Address - Country:US
Mailing Address - Phone:413-774-6301
Mailing Address - Fax:866-644-0871
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:GREENFIELD HEALTH CENTER
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1521
Practice Address - Country:US
Practice Address - Phone:413-774-6301
Practice Address - Fax:866-644-0871
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA 1559363AM0700X
MAPA1559363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP1899Medicare ID - Type Unspecified
P82738Medicare UPIN