Healthcare Provider Details

I. General information

NPI: 1548024771
Provider Name (Legal Business Name): AMY NOSAL CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 DEPOT ST
HANCOCK MI
49930-2042
US

IV. Provider business mailing address

540 DEPOT ST
HANCOCK MI
49930-2042
US

V. Phone/Fax

Practice location:
  • Phone: 906-482-7382
  • Fax: 906-482-9410
Mailing address:
  • Phone: 906-482-7382
  • Fax: 906-482-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: