Healthcare Provider Details

I. General information

NPI: 1467004416
Provider Name (Legal Business Name): AMELIA SCHAFER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LAKESHORE DR
ISHPEMING MI
49849-1367
US

IV. Provider business mailing address

208 W MICHIGAN AVE APT 2J
YPSILANTI MI
48197-5562
US

V. Phone/Fax

Practice location:
  • Phone: 906-486-4431
  • Fax:
Mailing address:
  • Phone: 616-548-0172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704387300
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: