Provider Demographics
NPI:1487805495
Name:TRUCKEY, AMY E (PAC, ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:TRUCKEY
Suffix:
Gender:F
Credentials:PAC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 HOLMGREN WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5224
Mailing Address - Country:US
Mailing Address - Phone:920-888-2828
Mailing Address - Fax:920-338-6869
Practice Address - Street 1:2411 HOLMGREN WAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5224
Practice Address - Country:US
Practice Address - Phone:920-888-2828
Practice Address - Fax:920-338-6869
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI288823207V00000X
WI2888-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology