Provider Demographics
NPI:1467489575
Name:ZAHN, AMY JO (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:ZAHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:MAERZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 15TH AVENUE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1160
Mailing Address - Country:US
Mailing Address - Phone:414-768-5430
Mailing Address - Fax:414-762-4225
Practice Address - Street 1:902 MILWAUKEE AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-2118
Practice Address - Country:US
Practice Address - Phone:414-764-4003
Practice Address - Fax:414-764-4005
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126706363L00000X
WI2912-003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
02120-0274Medicare PIN