Provider Demographics
NPI:1609058288
Name:BAIN, AMY JEAN (CPNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JEAN
Last Name:BAIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 1ST PL NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2744
Mailing Address - Country:US
Mailing Address - Phone:630-981-4123
Mailing Address - Fax:425-651-4244
Practice Address - Street 1:175 1ST PL NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2744
Practice Address - Country:US
Practice Address - Phone:630-981-4123
Practice Address - Fax:425-651-4244
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60455433363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics