MEDICARE: AMY J CONNOLLY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	13188-033	WI

General Provider Information

NPI Number	:	1841909504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY J CONNOLLY NP

Provider Business Mailing Address
First Line	:	1300 S CALHOUN RD
Second Line	:	SECOND FLOOR
City	:	BROOKFIELD
State	:	WI
Zip	:	53005
Country	:	US
Telephone Number	:	414-253-8100
Fax Number	:	800-553-4012

Provider Business Practice Location Address
First Line	:	1300 S CALHOUN RD
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-6810
Country	:	US
Telephone Number	:	414-253-8100
Fax Number	:	800-553-4012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	03/14/2026

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