Provider Demographics
NPI:1427318765
Name:ANDERSON, AMY MARIE (RN, RCS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, RCS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:FABRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7046 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9451
Mailing Address - Country:US
Mailing Address - Phone:608-469-6967
Mailing Address - Fax:
Practice Address - Street 1:7046 BRIAR LN
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9451
Practice Address - Country:US
Practice Address - Phone:608-469-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167026-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse