Individual
AMY ROSE CRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 771-0070
(262) 885-6340
Mailing address
4006 WASHINGTON RD, KENOSHA, WI 53144-4819
(262) 656-0044
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
15474-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
15474-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100285100
—
WI
Enumeration date
06/19/2024
Last updated
07/09/2026
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