Provider Demographics
NPI:1891977443
Name:STOLZ, AMY E (APN)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:STOLZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:ASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN-RN
Mailing Address - Street 1:1200 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-2112
Mailing Address - Country:US
Mailing Address - Phone:815-490-1600
Mailing Address - Fax:815-490-1881
Practice Address - Street 1:1200 W STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102-2112
Practice Address - Country:US
Practice Address - Phone:815-490-1600
Practice Address - Fax:815-490-1881
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030432363LP0200X
CO183640163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid