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
StateLicense IDTaxonomies
WI8390363LF0000X
WI8390-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100078178Medicaid