Provider Demographics
NPI:1699761585
Name:GRUWELL, AMY MARIE (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:GRUWELL
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 1:1900 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2747
Mailing Address - Country:US
Mailing Address - Phone:307-577-7737
Mailing Address - Fax:307-577-0049
Practice Address - Street 1:1900 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2747
Practice Address - Country:US
Practice Address - Phone:307-577-7737
Practice Address - Fax:307-577-0049
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19507.318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY315275OtherBC/BS
WY611665901OtherDEPT OF LABOR
WY120223500Medicaid
WYP00334676Medicare PIN
WY611665901OtherDEPT OF LABOR