Provider Demographics
NPI:1568671220
Name:QUIZ, AMELIA E (APN ADVANCE PRACTICE)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:E
Last Name:QUIZ
Suffix:
Gender:F
Credentials:APN ADVANCE PRACTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MEDIC WAY
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135
Mailing Address - Country:US
Mailing Address - Phone:765-720-7085
Mailing Address - Fax:765-653-0562
Practice Address - Street 1:305 MEDIC WAY
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135
Practice Address - Country:US
Practice Address - Phone:765-720-7085
Practice Address - Fax:765-653-0562
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28155359A163WW0000X
IN71002412A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN254640AMedicare PIN