Provider Demographics
NPI:1841909504
Name:CONNOLLY, AMY J (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:6901 W EDGERTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4420
Mailing Address - Country:US
Mailing Address - Phone:414-325-5244
Mailing Address - Fax:414-421-3772
Practice Address - Street 1:6901 W EDGERTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4420
Practice Address - Country:US
Practice Address - Phone:414-325-5244
Practice Address - Fax:414-421-3772
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2023-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI13188-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner