AMY E FANNIN (NPI# 1093124265) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093124265 |
| Entity Type | Individual |
| Full Name | AMY E FANNIN |
| Credential | APNP |
| Practice Address |
421 Camelot Dr Fond Du Lac WI 54935-8335 |
| Mailing Address |
420 E Division St Fond Du Lac WI 54935-4560 |
| Practice Telephone | 9209268282 |
| Mailing Telephone | 9209268340 |
| Mailing Fax Number | 9209268370 |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2016-12-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
5904-33 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
421 CAMELOT DR |
| City | FOND DU LAC |
| State | WI |
| Zip Code | 54935-8335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366433435 | Elizabeth S Bensen | Physical Medicine & Rehabilitation | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2005-10-28 |
| 1962028522 | Kelley Cantu | Massage Therapist | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2020-06-19 |
| 1306473780 | Samantha Jo Krones | Physician Assistant | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2020-03-25 |
| 1962975292 | Tyler Schwarz | Specialist/Technologist | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2019-01-09 |
| 1154808491 | Greta Marie Breckbill | Audiologist | 421 Camelot Dr, Fond Du Lac, WI 54935 | 2018-07-19 |
| 1861991424 | Jacklyn Osborne | Nurse Practitioner | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2018-02-08 |
| 1932620689 | Michael Schraufnagel | Physical Therapist | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2017-07-03 |
| 1477083608 | Tristan G Brown | Optometrist | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2017-06-20 |
| 1306379433 | Ashley Beyer | Specialist/Technologist | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2017-04-05 |
| 1417498254 | Allieson Elizabeth Mirsberger | Massage Therapist | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2017-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609482249 | Keziah Sherri Love | Counselor | W390 Wi-23, Fond Du Lac, WI 54935 | 2020-09-18 |
| 1891341988 | Cynthia Louise Singleton | Nurse Practitioner | 16 E 13th St., Fond Du Lac, WI 54935 | 2019-08-14 |
| 1083183297 | Elena Alexandra Giese | Nurse Practitioner | 430 E. Division St, Fond Du Lac, WI 54935 | 2018-11-16 |
| 1669963740 | Elizabeth Anne Machi | Student in an Organized Health Care Education/Training Program | 885 Western Ave Ste 300, Fond Du Lac, WI 54935 | 2018-05-23 |
| 1184150021 | Jordan Moehn | Specialist/Technologist | 633 Prairie Pkwy, Fond Du Lac, WI 54935 | 2017-05-11 |
| 1467856336 | Chuentao Ho | Specialist/Technologist | 45 South National Ave., Fond Du Lac, WI 54935 | 2014-10-21 |
| 1437587961 | Paula Seeley | Nurse Practitioner | 63 West Pioneer Rd, Fond Du Lac, WI 54935 | 2013-10-18 |
| 1144516030 | Bonnie Kay Mallon | Registered Nurse | 118 E 9th St, Fond Du Lac, WI 54935 | 2011-06-20 |
| 1770885600 | Holly Shepard | Counselor | 23 W Scott St., Fond Du Lac, WI 54935 | 2010-11-29 |
| 1437479110 | Ruth Marie Bohn | Occupational Therapy Assistant | 244 North Macy Street, Fond Du Lac, WI 54935 | 2010-06-04 |
| Find all providers in zip 54935 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265964233 | Robin A Strauss | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2017-03-29 |
| 1144637265 | Laura R Suprenand | Nurse Practitioner | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2014-07-21 |
| 1609202779 | Rachael Kolaske | Nurse Practitioner | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2013-09-20 |
| 1720413651 | Megan Diener | Nurse Practitioner | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2013-09-11 |
| 1952735516 | Lisa Mae Michels | Nurse Practitioner | 480 E Division St, Fond Du Lac, WI 54935-3734 | 2013-08-30 |
| 1922432806 | Jean N Rusch | Nurse Practitioner | 1088 S Main St, Fond Du Lac, WI 54935-6102 | 2013-08-27 |
| 1942552658 | Mary J Dalzell | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2012-10-04 |
| 1568602530 | Kathleen A Grochowski | Nurse Practitioner | 145 N Main St, Fond Du Lac, WI 54935-3423 | 2009-03-03 |
| 1124245253 | Lori J Wendt | Nurse Practitioner | 480 E Division St, Fond Du Lac, WI 54935-3734 | 2007-04-19 |
| 1093836751 | Jammi G Cairns | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2007-04-02 |
| Find all providers in FOND DU LAC | ||||
| City | FOND DU LAC |
| Zip Code | 54935 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.