MEDICARE: MRS. AMY M HACKMAN NP

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
1	363L00000X	Nurse Practitioner	4704176353	MI

General Provider Information

NPI Number	:	1558327049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY M HACKMAN NP

Provider Business Mailing Address
First Line	:	1555 E CHICAGO RD
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-1993
Country	:	US
Telephone Number	:	269-651-7114
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 E CHICAGO RD
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-1993
Country	:	US
Telephone Number	:	269-651-7114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	04/30/2013

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