Provider Demographics
NPI:1679915466
Name:PUTNEY, AMY DIANE (MA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DIANE
Last Name:PUTNEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:READLYN
Mailing Address - State:IA
Mailing Address - Zip Code:50668-0313
Mailing Address - Country:US
Mailing Address - Phone:319-830-1254
Mailing Address - Fax:
Practice Address - Street 1:315 E SAN MARNAN DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5837
Practice Address - Country:US
Practice Address - Phone:319-830-1254
Practice Address - Fax:319-883-3507
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist