Healthcare Provider Details

I. General information

NPI: 1396275517
Provider Name (Legal Business Name): AMY R MATTICHAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY PAINTER

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 E BLUE GRASS RD
MT PLEASANT MI
48858-6020
US

IV. Provider business mailing address

1701 LAKE LANSING RD STE 100
LANSING MI
48912-3798
US

V. Phone/Fax

Practice location:
  • Phone: 989-317-0565
  • Fax: 989-317-0567
Mailing address:
  • Phone: 517-485-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704269133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: