Individual
AMY LIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
309 PAGE AVE, JACKSON, MI 49201-2419
(517) 787-1234
(517) 787-9140
Mailing address
24 FRANK LLOYD WRIGHT DR LBBY J2000, ANN ARBOR, MI 48105-9484
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
5601002245
MI
363A00000X
Physician Assistant
Primary
5601002245
MI
Other
Enumeration date
03/03/2006
Last updated
07/12/2018
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