Provider Demographics
NPI:1710150537
Name:WEISBROT, AMY J (RN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:J
Last Name:WEISBROT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 N FRATNEY ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1747
Mailing Address - Country:US
Mailing Address - Phone:414-963-0967
Mailing Address - Fax:414-963-0967
Practice Address - Street 1:3426 N FRATNEY ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1747
Practice Address - Country:US
Practice Address - Phone:414-963-0967
Practice Address - Fax:414-963-0967
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI92224030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse