Provider Demographics
NPI:1689046187
Name:AMATO, EMILY LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREN
Last Name:AMATO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 E BELTLINE AVE SE STE 130
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4303
Mailing Address - Country:US
Mailing Address - Phone:616-204-2163
Mailing Address - Fax:616-717-5145
Practice Address - Street 1:1310 E BELTLINE AVE SE STE 130
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4303
Practice Address - Country:US
Practice Address - Phone:616-204-2163
Practice Address - Fax:616-717-5145
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007582363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical