Basic Information
| Provider Information | |||||||||
| NPI: | 1306870126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORTHING | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 HANNAH BLVD STE 212 | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173191831 | ||||||||
| FaxNumber: | 5176642930 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 HANNAH BLVD STE 212 | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173191831 | ||||||||
| FaxNumber: | 5176642930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/19/2010 | ||||||||
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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 | 363A00000X | 5601002960 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1038858 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | 1038858 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 2053313130 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 1038858 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 7965762 | 01 | MI | AETNA | OTHER | P00283897 | 01 | MI | RAILROAD MEDICARE | OTHER |