MEDICARE: AMY E TRUCKEY PAC, ATC

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	207V00000X	Obstetrics & Gynecology Physician	288823	WI
2	363A00000X	Physician Assistant	2888-23	WI

General Provider Information

NPI Number	:	1487805495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY E TRUCKEY PAC, ATC

Provider Business Mailing Address
First Line	:	2411 HOLMGREN WAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5224
Country	:	US
Telephone Number	:	920-888-2828
Fax Number	:	920-338-6869

Provider Business Practice Location Address
First Line	:	2411 HOLMGREN WAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5224
Country	:	US
Telephone Number	:	920-888-2828
Fax Number	:	920-338-6869

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	09/23/2025

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Directions to “ AMY E TRUCKEY PAC, ATC” Practice Location

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