Healthcare Provider Details

I. General information

NPI: 1932703022
Provider Name (Legal Business Name): AMY M DEWEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 07/07/2023
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 WELLES ST
FORTY FORT PA
18704-4968
US

IV. Provider business mailing address

30 RELIANCE DR
WILKES BARRE PA
18702-1638
US

V. Phone/Fax

Practice location:
  • Phone: 570-718-4140
  • Fax:
Mailing address:
  • Phone: 570-709-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN629005
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP025374
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: