Provider Demographics
NPI:1780887885
Name:WESSNER, AMY CATHERINE (CPM, LDM)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CATHERINE
Last Name:WESSNER
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CATHERINE
Other - Last Name:WESSNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM, LDM
Mailing Address - Street 1:1453 REDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5523
Mailing Address - Country:US
Mailing Address - Phone:541-916-8333
Mailing Address - Fax:541-843-1010
Practice Address - Street 1:1453 REDWOOD CIR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5523
Practice Address - Country:US
Practice Address - Phone:541-916-8333
Practice Address - Fax:541-843-1010
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEMLD10145369176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife