Healthcare Provider Details

I. General information

NPI: 1275871683
Provider Name (Legal Business Name): AMY JEAN GUTOWSKI NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22101 MOROSS RD
DETROIT MI
48236-2148
US

IV. Provider business mailing address

732 N 9TH ST
SAINT CLAIR MI
48079-4853
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-3497
  • Fax:
Mailing address:
  • Phone: 734-740-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number4704234754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: