Provider Demographics
NPI:1770571820
Name:YOUNG, AMY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:645 E MISSOURI AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:602-262-8900
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:6780 W THUNDERBIRD RD STE A105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:602-595-0525
Practice Address - Fax:602-595-2470
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2018-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003682363A00000X
AZ4872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI139497OtherGREAT LAKES HEALTH PLAN
MI275OtherCOMMUNITY CHOICE
MI1010619OtherMCLAREN HEALTH PLAN
970025690OtherRAILROAD MEDICARE
MI3500576OtherMOLINA HEALTH CARE
MI1010619OtherMCLARENHEALTHADVANTAGE
MI1010619OtherMCLARENHEALTHADVANTAGE
0M93030P05Medicare ID - Type Unspecified
P55792Medicare UPIN
MI0G36111-071Medicare PIN