Healthcare Provider Details

I. General information

NPI: 1770170649
Provider Name (Legal Business Name): AMY M WULKE DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 ROOT ST
FLINT MI
48503-1516
US

IV. Provider business mailing address

225 E 5TH ST STE 300
FLINT MI
48502-1641
US

V. Phone/Fax

Practice location:
  • Phone: 810-406-4932
  • Fax: 810-820-2892
Mailing address:
  • Phone: 810-406-4246
  • Fax: 810-424-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704271791
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704271791
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: