Provider Demographics
NPI:1104931583
Name:SWICHTENBERG, AMY RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RENEE
Last Name:SWICHTENBERG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13281 N 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6054
Mailing Address - Country:US
Mailing Address - Phone:623-826-8209
Mailing Address - Fax:
Practice Address - Street 1:3003 N CENTRAL AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2902
Practice Address - Country:US
Practice Address - Phone:855-821-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ129583Medicare PIN