Provider Demographics
NPI:1760764351
Name:HOWARD, AMY M (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:HOWARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 GETZ ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804
Mailing Address - Country:US
Mailing Address - Phone:260-212-1900
Mailing Address - Fax:260-222-2827
Practice Address - Street 1:1355 GETZ ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-212-1900
Practice Address - Fax:260-222-2827
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71003654A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000730251OtherANTHEM
IN201033260Medicaid
IN000000730251OtherANTHEM