# AMY R SURDAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1629099312
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 18161.0312 | WY | Yes |

## Other

- **Enumeration date:** 07/21/2006
- **Last updated:** 06/28/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 121544200 | — | WY |
| 01 | — | 23339 | WINHEALTH PARTNERS | WY |
| 01 | — | 313763 | BLUE SHIELD | WY |
| 01 | — | 82009A055 | WPS TRIWEST | WY |
| 01 | — | P00251860 | RAILROAD MEDICARE | WY |