Provider Demographics
NPI:1053007211
Name:WILLMARTH, AMBER (NP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WILLMARTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:CORNELL
Mailing Address - State:WI
Mailing Address - Zip Code:54732-0335
Mailing Address - Country:US
Mailing Address - Phone:715-827-0096
Mailing Address - Fax:
Practice Address - Street 1:1451 BLUESTEM BLVD STE F
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2619
Practice Address - Country:US
Practice Address - Phone:715-575-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13884-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner