Provider Demographics
NPI:1972687978
Name:OLDEJANS, AMY H (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:OLDEJANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 RIVERWALK DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9381
Mailing Address - Country:US
Mailing Address - Phone:517-999-4500
Mailing Address - Fax:517-999-4510
Practice Address - Street 1:2205 JOLLY RD
Practice Address - Street 2:STE B
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3983
Practice Address - Country:US
Practice Address - Phone:517-347-4085
Practice Address - Fax:517-347-4170
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008849363LA2200X
MI4704135672363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily