Healthcare Provider Details

I. General information

NPI: 1194271411
Provider Name (Legal Business Name): AMY STIER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13697 15 MILE RD
MARSHALL MI
49068-8533
US

IV. Provider business mailing address

13697 15 MILE RD
MARSHALL MI
49068-8533
US

V. Phone/Fax

Practice location:
  • Phone: 269-789-4905
  • Fax:
Mailing address:
  • Phone: 269-789-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704216443
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704216443
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: