| Provider / Organization | NPI | Date Certified |
|---|---|---|
| AMY KMETZ DITZEL | 1912120957 | 2024-11-08 |
Amy K Ditzel [F] graduated in 2000 and primarily specializes in Physician Assistant.
Amy Kmetz Ditzel is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1912120957. Registration indicates Amy Kmetz Ditzel is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant: Medical, ) (All Other Specialties & Provider Types, ) (Physician Assistant Medical, Physician Assistants & Advanced Practice Nursing Providers) (Physician Assistant, )
| PECOS ID | 4880858893 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Mrs. Amy Kmetz Ditzel PA-C |
| Practice Office Address | 4747 SKYLINE RD S SALEM, OR US |
| Practice Office Telephone | 5033997520 |
| Practice Office Fax | 5033627344 |
| Mailing Address | 875 OAK ST SE STE 390 SALEM, OR 97301 US |
| Business Telephone | 5033997520 |
| Business Fax | 5033627344 |
| Code | Practice | License No State |
|---|---|---|
| 363AM0700X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant: Medical All Other Specialties & Provider Types Physician Assistant Medical Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | PA03007
TX |