Provider Demographics
NPI:1437857349
Name:BLUHM, AMY L
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BLUHM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28602 MARTHA CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-2660
Mailing Address - Country:US
Mailing Address - Phone:414-861-0225
Mailing Address - Fax:
Practice Address - Street 1:7923 S LOOMIS RD
Practice Address - Street 2:
Practice Address - City:WIND LAKE
Practice Address - State:WI
Practice Address - Zip Code:53185-2069
Practice Address - Country:US
Practice Address - Phone:262-895-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130524-30163W00000X
WI14218-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI130524-30OtherDEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI14218-146OtherDEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES