Healthcare Provider Details

I. General information

NPI: 1699164715
Provider Name (Legal Business Name): AMY BOGERT-KUEBLER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 N 21ST ST
CAMP HILL PA
17011-2207
US

IV. Provider business mailing address

770 LONG LANE RD
KUTZTOWN PA
19530-9344
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-9880
  • Fax: 717-737-2765
Mailing address:
  • Phone: 610-683-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN259062L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: