Amy D Nielsen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601004677 Issued in MI

Practice address

100 Michigan St NE
10TH Floor, MC 249
Grand Rapids, MI 49503-2560

Phone

(616) 267-1925

Fax

(616) 267-1005

NPI assigned

May 27, 2006

Last updated

Dec 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amy D Blackburn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pennock Hospital

  dba Corewell Health Pennock Hospital Professional

  • Family Medicine Physician
  • Hastings, MI
  • NPI 1518186295
  NPD (past)
• Spectrum Health Hospitals

  dba Corewell Health Grand Rapids Hospitals Urgent Care

  • Urgent Care Clinic/Center
  • Grand Rapids, MI
  • NPI 1598712390
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1457308421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "10TH FLOOR, MC 249",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-267-1925",
            "fax_number": "616-267-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "AMY",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-27",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "BLACKBURN",
            "middle_name": "D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicholas William Nicoletti
• Rashea Crystal Nidefski, LBSW
• Jennifer Niedzwiecki, PHARMD
• Thomas Niedzwiecki
• Alexandrea Nielsen, LLMSW
• Elizabeth Maitner Nielsen, LMSW
• Michele A Nielsen, MA, LLP, LLPC
• Nancy Norma Nielsen I
• Rebecca Jo Nielsen, NP
• Kristine Marie Niemeyer, MSN, NP

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.