Provider Demographics
NPI:1659777019
Name:KOERS, AMY SUE (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:KOERS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CARR LN
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:PA
Mailing Address - Zip Code:16345-6125
Mailing Address - Country:US
Mailing Address - Phone:716-640-3075
Mailing Address - Fax:844-881-1031
Practice Address - Street 1:3023 ROUTE 430
Practice Address - Street 2:
Practice Address - City:GREENHURST
Practice Address - State:NY
Practice Address - Zip Code:14742
Practice Address - Country:US
Practice Address - Phone:716-483-5000
Practice Address - Fax:716-488-2414
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6853363LA2200X
NH074226-23363LA2200X
MECNP161200363LA2200X
RIAPRN01551363LA2200X
NY306911363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health