MEDICARE: NICOLE ELIZABETH AMSTUTZ CNM

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	367A00000X	Advanced Practice Midwife	236130	CA

General Provider Information

NPI Number	:	1902406929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ELIZABETH AMSTUTZ CNM

Provider Business Mailing Address
First Line	:	489 LA FLORESTA DR
Second Line	:
City	:	BREA
State	:	CA
Zip	:	92823-6312
Country	:	US
Telephone Number	:	831-297-8852
Fax Number	:

Provider Business Practice Location Address
First Line	:	5319 S 500 E STE C
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-7218
Country	:	US
Telephone Number	:	801-917-6104
Fax Number	:

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/15/2024

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