Individual
AMY VIOLA PETRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2002 S 11TH ST, NILES, MI 49120-4074
(269) 687-0200
(269) 684-0199
Mailing address
6416 DEANS HILL RD, BERRIEN CENTER, MI 49102-9750
(269) 471-7741
(269) 471-1581
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
085002713
IL
363AM0700X
Medical Physician Assistant
Primary
5601006305
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649386319
—
MI
Enumeration date
08/22/2006
Last updated
03/14/2013
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