MEDICARE: MS. AMY L MAYERNIK MSN FNP-C

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	71004465A	IN

General Provider Information

NPI Number	:	1255770749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY L MAYERNIK MSN FNP-C

Provider Business Mailing Address
First Line	:	100 N DETROIT ST
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3329
Country	:	US
Telephone Number	:	574-267-6208
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N DETROIT ST
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3329
Country	:	US
Telephone Number	:	574-267-6208
Fax Number	:

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

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	05/07/2026

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