Wallis, Amy D

Wallis, Amy D is an individual health care provider with primary practice located at 5409 Avenue O , Fort Madison IA 52627-9601. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Wallis, Amy D can be contacted via phone (319) 376-2134.

Contact Information

Primary practice address
5409 Avenue O Fort Madison IA 52627-9601
Phone: (319) 376-2134
Fax: (319) 376-2188
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 71002282A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 100507 Iowa

Profile Details

NPI number 1275598864
LBN Legal business name Wallis, Amy D
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2006
Last updated Oct 6th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275598864 NPPES
Iowa Other 1275598864 WELLMARK BLUE CROSS BLUE SHIELD
Iowa MEDICAID 1275598864 WELLMARK BLUE CROSS BLUE SHIELD
Iowa Other P00456554 WELLMARK BLUE CROSS BLUE SHIELD
Iowa MEDICAID 200848020A WELLMARK BLUE CROSS BLUE SHIELD
Iowa Other CG3197 WELLMARK BLUE CROSS BLUE SHIELD

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