Provider Demographics
NPI:1720172000
Name:KOMPERDA, AMY L (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:KOMPERDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41850 W 11 MILE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1857
Mailing Address - Country:US
Mailing Address - Phone:248-860-4634
Mailing Address - Fax:248-282-5044
Practice Address - Street 1:41850 W 11 MILE RD STE 202
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1857
Practice Address - Country:US
Practice Address - Phone:248-860-4634
Practice Address - Fax:248-282-5044
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704166490363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner