=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619336476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY KATHRYN STEINBACH LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2016
-----------------------------------------------------
Last Update Date | 02/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N1966 DOMAIN DR
-----------------------------------------------------
City | KAUKAUNA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54130-9477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-470-5028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N1966 DOMAIN DR
-----------------------------------------------------
City | KAUKAUNA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54130-9477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-470-5028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 306519
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------