Provider Demographics
NPI: | 1932690880 |
---|---|
Name: | BOHLER, AMY LYNN (FNP-BC) |
Entity Type: | Individual |
Prefix: | |
First Name: | AMY |
Middle Name: | LYNN |
Last Name: | BOHLER |
Suffix: | |
Gender: | F |
Credentials: | FNP-BC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 8905 W LINCOLN AVE STE 515 |
Mailing Address - Street 2: | |
Mailing Address - City: | WEST ALLIS |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53227-2470 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 414-328-8650 |
Mailing Address - Fax: | 414-328-8660 |
Practice Address - Street 1: | 8905 W LINCOLN AVE STE 515 |
Practice Address - Street 2: | |
Practice Address - City: | WEST ALLIS |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53227-2470 |
Practice Address - Country: | US |
Practice Address - Phone: | 414-328-8650 |
Practice Address - Fax: | 414-328-8660 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-05-27 |
Last Update Date: | 2022-03-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 8390 | 363LF0000X |
WI | 8390-033 | 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 100078178 | Medicaid |