Provider Demographics
NPI:1164586624
Name:SCHWARZENBART, AMY JO (APNP, PMHCNS-BC, RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:SCHWARZENBART
Suffix:
Gender:F
Credentials:APNP, PMHCNS-BC, RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:KUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN C
Mailing Address - Street 1:PO BOX 22040
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2040
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:301 E SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54305-3725
Practice Address - Country:US
Practice Address - Phone:920-433-6073
Practice Address - Fax:920-431-0333
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI114406-030163WP0808X
MI4704344454363LP0808X
WI4178-33363LP0808X
WI4178033364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
2010007882OtherAMERICAN NURSES CREDENTIALING CENTER