Provider Demographics
NPI:1912149337
Name:BUCHENAU, AMY JOY (APN)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JOY
Last Name:BUCHENAU
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E STATE ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-1573
Mailing Address - Country:US
Mailing Address - Phone:815-988-8500
Mailing Address - Fax:
Practice Address - Street 1:2222 E STATE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-1573
Practice Address - Country:US
Practice Address - Phone:815-988-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16719530163W00000X
IL041284208163W00000X
IL209009880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse