Provider Demographics
NPI:1538166186
Name:ROY, AMY CATHERINE (NPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CATHERINE
Last Name:ROY
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:CATHERINE
Other - Last Name:ANGLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NPC
Mailing Address - Street 1:431 SWARTZ CT. STE. 200
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846
Mailing Address - Country:US
Mailing Address - Phone:616-841-2615
Mailing Address - Fax:616-828-1752
Practice Address - Street 1:431 SWARTZ CT. STE. 200
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846
Practice Address - Country:US
Practice Address - Phone:616-841-2615
Practice Address - Fax:616-828-1752
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4636668-10Medicaid
MIN81890007Medicare ID - Type UnspecifiedMEDICARE PART B #
MIQ25480Medicare UPIN