Provider Demographics
NPI:1992947048
Name:BURESH, AMY J (RN)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:J
Last Name:BURESH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 CUMBERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6372
Mailing Address - Country:US
Mailing Address - Phone:920-469-5684
Mailing Address - Fax:
Practice Address - Street 1:2423 CUMBERLAND WAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6372
Practice Address - Country:US
Practice Address - Phone:920-469-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130534-030163W00000X
WI130534030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health