Provider Demographics
NPI:1932799194
Name:EICHMAN, AMY SUE (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:EICHMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1145
Mailing Address - Country:US
Mailing Address - Phone:715-205-8516
Mailing Address - Fax:
Practice Address - Street 1:106 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1145
Practice Address - Country:US
Practice Address - Phone:715-205-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124164-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI233224Medicaid