Provider Demographics
NPI:1700869468
Name:YEATMAN, AMY C (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:C
Last Name:YEATMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:CHIRICHETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-431-5607
Mailing Address - Fax:
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-431-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46798-021208VP0014X
WI46798-21207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WII15309Medicare UPIN