Provider Demographics
NPI:1033362066
Name:UPHUS, ANNEMARIE (APNP, PMHNP-BC, CNM)
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:UPHUS
Suffix:
Gender:F
Credentials:APNP, PMHNP-BC, CNM
Other - Prefix:
Other - First Name:ANNEMARIE
Other - Middle Name:
Other - Last Name:SCHIERECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:1531 S MADISON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1800
Practice Address - Country:US
Practice Address - Phone:920-730-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148901-32367A00000X
WI6092-33363L00000X
WI6092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
12792OtherAMERICAN MIDWIFERY CERTIFICATION
WI1033362066Medicaid
WIK400172731Medicare PIN