Provider Demographics
NPI:1295186971
Name:GOETZ, AMBER (NP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GOETZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33896 S TOWNLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:DRUMMOND ISLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49726-9504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33896 S TOWNLINE ROAD
Practice Address - Street 2:
Practice Address - City:DRUMMOND ISLAND
Practice Address - State:MI
Practice Address - Zip Code:49726
Practice Address - Country:US
Practice Address - Phone:906-493-5221
Practice Address - Fax:906-493-5695
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704258308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily