Provider Demographics
NPI:1750770640
Name:HANNEMAN, AMY JO (RN MSN AGNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:HANNEMAN
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Gender:F
Credentials:RN MSN AGNP
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Mailing Address - Street 1:425 PINE RIDGE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4123
Mailing Address - Country:US
Mailing Address - Phone:715-847-2019
Mailing Address - Fax:715-843-1315
Practice Address - Street 1:425 PINE RIDGE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4123
Practice Address - Country:US
Practice Address - Phone:715-847-2019
Practice Address - Fax:715-843-1315
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI113915-30363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology