Provider Demographics
NPI:1669090999
Name:HARTZ, AMELIA MARY (PA-C)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MARY
Last Name:HARTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 HEALTHY WAY STE D
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-1180
Mailing Address - Country:US
Mailing Address - Phone:812-450-8720
Mailing Address - Fax:
Practice Address - Street 1:4949 HEALTHY WAY STE D
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-1180
Practice Address - Country:US
Practice Address - Phone:812-450-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003054A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300023007Medicaid