| Doctor Name: | AMY E FANNIN |
| NPI Number: | 1093124265 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APNP |
| License Number: | 5904-33 |
| Business Practice Address: | 430 E Division St Fond Du Lac, WI - 549354560 |
| Business Phone Number: | 9209292300 |
| Business Fax Number: | |
| Mailing Address: | 3467 Oregon St, OSHKOSH |
| State: | WI |
| Postal Code: | 549027190 |
| Phone Number: | 9206420005 |
| Fax Number: | |
| NPI Enumeration Date: | 08/12/2014 |
| NPI Last Update Date: | 08/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 5904-33 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |