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NPI Code Detail

MEDICARE: AMY LYNN ANTONICH APNP

MEDICARE: AMY LYNN ANTONICH APNP
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
1207Q00000XFamily Medicine Physician8031-33WI
2363LF0000XFamily Nurse Practitioner8031-33WI

General Provider Information

NPI Number : 1922519339
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LYNN ANTONICH APNP
Provider Business Mailing Address
First Line : 17 EXCHANGE ST W
Second Line : STE 622
City : SAINT PAUL
State : MN
Zip : 55102-1225
Country : US
Telephone Number : 651-297-9141
Fax Number :
Provider Business Practice Location Address
First Line : 17 EXCHANGE ST W
Second Line : STE 622
City : SAINT PAUL
State : MN
Zip : 55102-1225
Country : US
Telephone Number : 651-297-9141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2017
Last Update Date : 10/25/2019

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Directions to “ AMY LYNN ANTONICH APNP” Practice Location

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