Individual
AMY JO HANNEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN MSN AGNP
Contact information
Practice address
425 PINE RIDGE BLVD, SUITE 300, WAUSAU, WI 54401-4123
(715) 847-2019
(715) 843-1315
Mailing address
425 PINE RIDGE BLVD, SUITE 300, WAUSAU, WI 54401-4123
(715) 847-2019
(715) 843-1315
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
113915-30
WI
363LG0600X
Gerontology Nurse Practitioner
113915-30
WI
Other
Enumeration date
01/14/2015
Last updated
01/14/2015
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