Individual
AMY CAVANAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
825 WALTON DR, PLYMOUTH, WI 53073-5022
(920) 892-4322
Mailing address
825 WALTON DR, PLYMOUTH, WI 53073-5022
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
14309-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100252605
—
WI
Enumeration date
08/23/2023
Last updated
01/18/2024
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