Provider Demographics
NPI:1720300049
Name:KING, AMY (RN, WCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RN, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-0151
Mailing Address - Country:US
Mailing Address - Phone:207-768-4457
Mailing Address - Fax:207-768-4456
Practice Address - Street 1:146 ACADEMY ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3102
Practice Address - Country:US
Practice Address - Phone:207-768-4457
Practice Address - Fax:207-768-4456
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER052478163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care