Provider Demographics
NPI:1174599013
Name:CHURCHILL, AMY SUZANNE (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 EAST BELL ROAD
Mailing Address - Street 2:145
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:602-354-3172
Mailing Address - Fax:602-354-3173
Practice Address - Street 1:5425 EAST BELL RD.
Practice Address - Street 2:145
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:602-354-3172
Practice Address - Fax:602-354-3173
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily