MEDICARE: AMY ALTAMASH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704316352	MI
2	163W00000X	Registered Nurse	361679	OH
3	163W00000X	Registered Nurse	0001241905	VA

General Provider Information

NPI Number	:	1003288457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ALTAMASH NP

Provider Business Mailing Address
First Line	:	7443 JACKMAN RD
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9223
Country	:	US
Telephone Number	:	734-850-0100
Fax Number	:	734-850-0112

Provider Business Practice Location Address
First Line	:	7443 JACKMAN RD
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9223
Country	:	US
Telephone Number	:	734-850-0100
Fax Number	:	734-850-0112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/29/2015

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Directions to “ AMY ALTAMASH NP” Practice Location

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