Provider Demographics
NPI:1093169302
Name:ALBACHTEN, AMELIA EMILEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:EMILEE
Last Name:ALBACHTEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631671
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1671
Mailing Address - Country:US
Mailing Address - Phone:877-227-8823
Mailing Address - Fax:313-578-6393
Practice Address - Street 1:770 KENMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8621
Practice Address - Country:US
Practice Address - Phone:616-272-3533
Practice Address - Fax:616-259-4839
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704281244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner