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NPI Code Detail

MEDICARE: AMBER L KRUEGER PA

MEDICARE: AMBER L KRUEGER PA
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
1363A00000XPhysician Assistant2172WI

General Provider Information

NPI Number : 1578763405
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER L KRUEGER PA
Provider Business Mailing Address
First Line : 420 E DIVISION ST
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-4560
Country : US
Telephone Number : 920-926-8340
Fax Number : 920-926-8370
Provider Business Practice Location Address
First Line : 333 N GREEN BAY RD
Second Line :
City : NEENAH
State : WI
Zip : 54956-1954
Country : US
Telephone Number : 920-364-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2007
Last Update Date : 06/23/2021

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