Healthcare Provider Details

I. General information

NPI: 1578763405
Provider Name (Legal Business Name): AMBER L KRUEGER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N GREEN BAY RD
NEENAH WI
54956-1954
US

IV. Provider business mailing address

420 E DIVISION ST
FOND DU LAC WI
54935-4560
US

V. Phone/Fax

Practice location:
  • Phone: 920-364-3600
  • Fax:
Mailing address:
  • Phone: 920-926-8340
  • Fax: 920-926-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2172
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: