Provider Demographics
NPI:1699843904
Name:PARENT, AMY J (APNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:PARENT
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 S 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-3315
Mailing Address - Country:US
Mailing Address - Phone:414-327-0714
Mailing Address - Fax:
Practice Address - Street 1:12601 W HAMPTON AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:BUTLER
Practice Address - State:WI
Practice Address - Zip Code:53007-1705
Practice Address - Country:US
Practice Address - Phone:262-373-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2461-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIQ67842Medicare UPIN