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General NPI Number Information
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NPI Number | 1487023370
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Entity Type | Individual
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Provider Name | AMY MICHELLE WILEY CNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 128 E. APPLE ST.
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City | DAYTON
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State | OH
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Zip | 45409-2793
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Country | US
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Telephone | 937-208-2312
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 BAYSIDE DR
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City | RIVERSIDE
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State | OH
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Zip | 45431-2103
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Country | US
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Telephone | 937-479-6659
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | COA. 17530-NP
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License Number State | OH
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