Provider Demographics
NPI:1902507056
Name:CHURCH, AMY LENAE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LENAE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 WHEATRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9012
Mailing Address - Country:US
Mailing Address - Phone:316-772-1944
Mailing Address - Fax:
Practice Address - Street 1:2101 N WALDRON ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1197
Practice Address - Country:US
Practice Address - Phone:419-462-0694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5381868042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine