Provider Demographics
NPI:1194952036
Name:HEWUSE, AMY L (NP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:HEWUSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:725 AMERICAN AVE
Mailing Address - Street 2:PHC REGIONAL CANCER CENTER
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5031
Mailing Address - Country:US
Mailing Address - Phone:262-928-2570
Mailing Address - Fax:262-928-5194
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:PHC REGIONAL CANCER CENTER
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-2570
Practice Address - Fax:262-928-5194
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI151149363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
683750651Medicare PIN