Provider Demographics
NPI:1649601477
Name:CARUSO, AMY KATHLEEN (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:CARUSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:KATHLEEN
Other - Last Name:INCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 0446 24 FRANK LLOYD WRIGHT DR. LOBBY J
Mailing Address - Street 2:IHA
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5301 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-3325
Practice Address - Fax:734-712-5525
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704154413364SN0000X, 363L00000X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner