Healthcare Provider Details

I. General information

NPI: 1588224919
Provider Name (Legal Business Name): AMY BJORKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N MEADE ST
APPLETON WI
54911-3454
US

IV. Provider business mailing address

1818 N MEADE ST
APPLETON WI
54911-3454
US

V. Phone/Fax

Practice location:
  • Phone: 920-636-5437
  • Fax: 920-735-7618
Mailing address:
  • Phone: 920-636-5437
  • Fax: 920-735-7618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9290
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: