AMY LANDIS FORMYDUVAL (NPI# 1588033450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588033450 |
| Entity Type | Individual |
| Full Name | AMY LANDIS FORMYDUVAL |
| Practice Address |
6404 Spicewood St Wilmington NC 28405-7756 |
| Practice Telephone | 9108406802 |
| Mailing Telephone | 9108406802 |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2015-09-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 203176 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
6404 SPICEWOOD ST |
| City | WILMINGTON |
| State | NC |
| Zip Code | 28405-7756 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376155507 | Evan Michael Vallee | Dentist | 5023 Market Street Wilmington, Wilmington, NC 28405 | 2020-08-19 |
| 1447725098 | Addictioncare 101 | Psychiatry & Neurology | 311 4 E Judges Road, Wilmington, NC 28405 | 2018-10-10 |
| 1659861649 | Brianna Jane Gausman | Physical Therapist | 6752 Parker Farm Dr Ste 1b, Wilmington, NC 28405 | 2018-05-15 |
| 1205346756 | Good Night Medical of Ohio, LLC | Durable Medical Equipment & Medical Supplies | 6427a Windmill Way, Wilmington, NC 28405 | 2017-10-10 |
| 1710345400 | Martha Arielle Walker | Physician Assistant | 6727 Parker Farm Dr, Wilmington, NC 28405 | 2016-02-09 |
| 1033549910 | Christine Urban Bruin | Psychologist | 510 Military Cutoff Rd., Suite 120, Wilmington, NC 28405 | 2013-11-14 |
| 1487083358 | Aci Support Specialists | Day Training, Developmentally Disabled Services | 117 Spartan Road, Wilmington, NC 28405 | 2013-11-01 |
| 1487902334 | Carolina Vision Associates, Od, Pa | Optometrist | 5301 B Market St, Carolina Vison Associates, Od, Pa, Wilmington, NC 28405 | 2012-08-27 |
| 1568718328 | Cameron Nichole Ford | Occupational Therapy Assistant | 5004 Hunters Trl, Apt 5, Wilmington, NC 28405 | 2012-07-31 |
| 1881959534 | Ashley Brennen Cook | Speech-Language Pathologist | 4613 Trafalgar Rd, Wilmington, NC 28405 | 2012-07-09 |
| Find all providers in zip 28405 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942550728 | Bryan Cole Chalk | Nurse Anesthetist, Certified Registered | 2131 S 17th Street, Wilmington, NC 28401 | 2012-09-19 |
| 1316210388 | Anesthesia Care Associates Inc. LLC | Nurse Anesthetist, Certified Registered | 7 Madelyn Ave, Wilmington, DE 19803-3964 | 2012-02-21 |
| 1891020103 | Jessica Lynn Jeffries | Nurse Anesthetist, Certified Registered | 5003 Lady Fern Ct, Wilmington, NC 28409-3976 | 2009-10-05 |
| 1780863068 | John R Shulse | Nurse Anesthetist, Certified Registered | 1602 Physicians Dr Ste 104, Wilmington, NC 28401-7350 | 2007-11-02 |
| 1073652780 | Sharon A Griffith | Nurse Anesthetist, Certified Registered | 807 W Main St, Wilmington, OH 45177-0868 | 2007-02-06 |
| 1073662839 | Paula Kay Lavigne | Nurse Anesthetist, Certified Registered | 1415 Medical Center Dr, Wilmington, NC 28401 | 2007-01-10 |
| 1033142765 | Cynthia Merrell | Nurse Anesthetist, Certified Registered | 2131 South 17th Street, Wilmington, NC 28401 | 2006-07-08 |
| 1902836059 | Ellen Cosby | Nurse Anesthetist, Certified Registered | 2005 Limestone Rd, Suite 5, Wilmington, DE 19808-5505 | 2006-07-04 |
| 1518997626 | Aleen Joy Wilker | Nurse Anesthetist, Certified Registered | 7th and Clayton Sts, 4th Floor Anesthesia, Wilmington, DE 19805 | 2006-07-04 |
| 1528096328 | William Keith Sturniolo | Nurse Anesthetist, Certified Registered | 5102 Masonboro Harbor Dr, Wilmington, NC 28409-4154 | 2006-06-29 |
| Find all providers in WILMINGTON | ||||
| City | WILMINGTON |
| Zip Code | 28405 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.