Provider Demographics
NPI:1689192809
Name:CODE, AMY J (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:CODE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:DZIESINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:HILLMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49746-0427
Mailing Address - Country:US
Mailing Address - Phone:989-354-2197
Mailing Address - Fax:989-354-1952
Practice Address - Street 1:11899 M 32
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:MI
Practice Address - Zip Code:49709-9374
Practice Address - Country:US
Practice Address - Phone:989-785-4855
Practice Address - Fax:989-785-2267
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid