Provider Demographics
NPI:1346546827
Name:CROFTS, AMY JEAN (RN, CNM, MSN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:CROFTS
Suffix:
Gender:F
Credentials:RN, CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-1720
Mailing Address - Country:US
Mailing Address - Phone:608-637-2920
Mailing Address - Fax:
Practice Address - Street 1:605 E COURT ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1720
Practice Address - Country:US
Practice Address - Phone:608-637-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84961-32367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife