Healthcare Provider Details

I. General information

NPI: 1164128807
Provider Name (Legal Business Name): AMY POPA MSN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 03/25/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HOBART ST
CADILLAC MI
49601-2379
US

IV. Provider business mailing address

302 HOBART ST
CADILLAC MI
49601-2379
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-2644
  • Fax: 231-876-5106
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704237331
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: