Provider Demographics
NPI:1902870835
Name:HOLWEGER, AMY K (FNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:K
Last Name:HOLWEGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:K
Other - Last Name:CLEGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2218 SHALLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-4290
Mailing Address - Country:US
Mailing Address - Phone:541-882-3818
Mailing Address - Fax:541-882-9800
Practice Address - Street 1:2218 SHALLOCK AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4290
Practice Address - Country:US
Practice Address - Phone:541-882-3818
Practice Address - Fax:541-882-9800
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR097006702N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR300000001SVE6EACOtherEHR CERTIFICATION NUMBER
OR097006702N1OtherLICENSE
ORMC0298287OtherDEA