Basic Information
| Provider Information | |||||||||
| NPI: | 1891075073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KUEHL | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | ELLEN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8767 SCHAAWE LAKE 24TH LN | ||||||||
| Address2: | |||||||||
| City: | RAPID RIVER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498789583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064740217 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 703 MCEWAN ST. | ||||||||
| Address2: | MIDMICHIGAN MEDICAL CENTER | ||||||||
| City: | CLARE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898025000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2011 | ||||||||
| LastUpdateDate: | 07/07/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704205280 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.