Healthcare Provider Details

I. General information

NPI: 1164586624
Provider Name (Legal Business Name): AMY JO SCHWARZENBART APNP, PMHCNS-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY JO KUST RN C

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E SAINT JOSEPH ST
GREEN BAY WI
54305-3725
US

IV. Provider business mailing address

PO BOX 22040
GREEN BAY WI
54305-2040
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-6073
  • Fax: 920-431-0333
Mailing address:
  • Phone: 920-445-7222
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number114406-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4178-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704344454
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4178-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: