Provider Demographics
NPI:1891075073
Name:WEBER, AMY ELLEN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELLEN
Last Name:WEBER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELLEN
Other - Last Name:KUEHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:8767 SCHAAWE LAKE 24TH LN
Mailing Address - Street 2:
Mailing Address - City:RAPID RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49878-9583
Mailing Address - Country:US
Mailing Address - Phone:906-474-0217
Mailing Address - Fax:
Practice Address - Street 1:703 MCEWAN ST.
Practice Address - Street 2:MIDMICHIGAN MEDICAL CENTER
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617
Practice Address - Country:US
Practice Address - Phone:989-802-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704205280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily