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NPI Code Detail

MEDICARE: AMY RENAE PHILIPPS FNP-C

MEDICARE: AMY RENAE PHILIPPS FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71007793AIN

General Provider Information

NPI Number : 1063910750
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY RENAE PHILIPPS FNP-C
Provider Business Mailing Address
First Line : 15341 MONTGOMERY ST
Second Line :
City : HEBRON
State : IN
Zip : 46341-9022
Country : US
Telephone Number : 219-741-2629
Fax Number :
Provider Business Practice Location Address
First Line : 2272 N MAIN ST
Second Line :
City : CROWN POINT
State : IN
Zip : 46307-1802
Country : US
Telephone Number : 219-661-5601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2018
Last Update Date : 02/13/2018

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