Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 6092-33 | WI |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 6092 | WI |
NPI | 1033362066 |
---|---|
Provider Name | Annemarie Uphus |
First Address | Green Bay, WI 54305-2487 |
Second Address | Appleton, WI 54915-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033362066 | (05) | WI |
12792 | AMERICAN MIDWIFERY CERTIFICATION (01) |