Provider Demographics
NPI:1790101954
Name:HASKAMP, AMY COREY (MSN, RN, PCNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:COREY
Last Name:HASKAMP
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Gender:F
Credentials:MSN, RN, PCNS-BC
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Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 3043
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-962-3400
Practice Address - Fax:317-963-5446
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2022-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28135729A364SP0200X
IN71004906364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201232660Medicaid
IN145590076Medicare PIN