Healthcare Provider Details

I. General information

NPI: 1790816270
Provider Name (Legal Business Name): AMY WOLZ CPHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E VANCE RD
OAK RIDGE TN
37830-6528
US

IV. Provider business mailing address

PO BOX 15004
KNOXVILLE TN
37901
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-4088
  • Fax: 866-674-2033
Mailing address:
  • Phone: 865-522-9730
  • Fax: 865-637-2520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN0000005744
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: