Provider Demographics
NPI:1295116804
Name:PARENTEAU, AMY (NP-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:PARENTEAU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12811 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1109
Mailing Address - Country:US
Mailing Address - Phone:734-283-4600
Mailing Address - Fax:734-283-4683
Practice Address - Street 1:12811 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1109
Practice Address - Country:US
Practice Address - Phone:734-283-4600
Practice Address - Fax:734-283-4683
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN88950002OtherMEDICARE
MIMI8823002OtherMEDICARE