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General NPI Number Information
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NPI Number | 1063910750
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Entity Type | Individual
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Provider Name | AMY RENAE PHILIPPS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/27/2018
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Last Update Date | 02/13/2018
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Provider Practice Location Address
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Address Line | 2272 N MAIN ST
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City | CROWN POINT
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State | IN
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Zip | 46307-1802
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Country | US
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Telephone | 219-661-5601
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Fax |
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Provider Business Mailing Address
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Address Line | 15341 MONTGOMERY ST
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City | HEBRON
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State | IN
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Zip | 46341-9022
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Country | US
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Telephone | 219-741-2629
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71007793A
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License Number State | IN
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