Individual
AMY MICHELLE PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
95022954
CA
363LP0200X
Pediatric Nurse Practitioner
APRN.CNP.021402
OH
363LP0200X
Pediatric Nurse Practitioner
Primary
NUR-2023-000730
NJ
Other
Enumeration date
07/28/2017
Last updated
02/02/2023
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