Individual
AMY E PERDOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1160 KEPLER DR, GREEN BAY, WI 54311-8321
(920) 288-5630
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
8778
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
8778
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100082580
—
WI
05
—
100082621
—
WI
Enumeration date
08/07/2018
Last updated
11/17/2024
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