Provider Demographics
NPI:1548746076
Name:SCHIEDERMAYER, AMY ANN
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ANN
Last Name:SCHIEDERMAYER
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 1:215 SUNNY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-4301
Mailing Address - Country:US
Mailing Address - Phone:920-585-6004
Mailing Address - Fax:
Practice Address - Street 1:215 SUNNY MEADOWS DR
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-4301
Practice Address - Country:US
Practice Address - Phone:920-585-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI123377163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice