Basic Information
| Provider Information | |||||||||
| NPI: | 1265585467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINN | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | PRIEZ | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1913 | ||||||||
| Address2: | |||||||||
| City: | HAMMOND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704041913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252949476 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15748 MEDICAL ARTS DR | ||||||||
| Address2: | |||||||||
| City: | HAMMOND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704031446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855420663 | ||||||||
| FaxNumber: | 9855420668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 05/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 68311-3205 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 1536687 | 05 | LA | MEDICAID |