Provider Demographics
NPI:1295935229
Name:MEYERS, AMY SUE (RN RCS, EMT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:RN RCS, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-3866
Mailing Address - Country:US
Mailing Address - Phone:920-210-2925
Mailing Address - Fax:
Practice Address - Street 1:122 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-3866
Practice Address - Country:US
Practice Address - Phone:920-210-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38255200Medicaid