Healthcare Provider Details

I. General information

NPI: 1104673730
Provider Name (Legal Business Name): AMY RAY RODWAY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. AMY RAY RODWAY

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 14010
APO AP
96543-4010
US

IV. Provider business mailing address

UNIT 14010
APO AP
96543-4010
US

V. Phone/Fax

Practice location:
  • Phone: 671-366-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number309957
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: