Provider Demographics
NPI:1821291758
Name:HUMMEL, AMY MARIE (CFNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIE
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BRIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-1334
Mailing Address - Country:US
Mailing Address - Phone:812-926-3133
Mailing Address - Fax:812-926-1668
Practice Address - Street 1:204 BRIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1334
Practice Address - Country:US
Practice Address - Phone:812-926-3133
Practice Address - Fax:812-926-1668
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000628363LF0000X
IN71000628A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200055610Medicaid
IN181790Medicare ID - Type Unspecified