Provider Demographics
NPI:1770849986
Name:WASSERMAN, AMY KATHLEEN ROURKE (APN, CNM)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATHLEEN ROURKE
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 N IONIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2836
Mailing Address - Country:US
Mailing Address - Phone:773-484-0524
Mailing Address - Fax:
Practice Address - Street 1:6705 N IONIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-2836
Practice Address - Country:US
Practice Address - Phone:773-484-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009468367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife