Amy Prout, RD | |
9252 N Green Bay Rd, Brown Deer, WI 53209-1104 | |
(414) 527-5261 | |
(414) 365-6356 |
Full Name | Amy Prout |
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Gender | Female |
Speciality | Dietitian, Registered |
Location | 9252 N Green Bay Rd, Brown Deer, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1518360882 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 2269 (Wisconsin) | Primary |
Provider Name | Ascension Medical Group-southeast Wisconsin Inc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1609881077 PECOS PAC ID: 8628980943 Enrollment ID: O20031104000421 |
Provider Name | Ascension Medical Group-fox Valley Wisconsin Inc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1730126392 PECOS PAC ID: 0244142420 Enrollment ID: O20031105000351 |
Mailing Address | Practice Location Address |
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Amy Prout, RD 9252 N Green Bay Rd, Brown Deer, WI 53209-1104 Ph: (414) 527-5261 | Amy Prout, RD 9252 N Green Bay Rd, Brown Deer, WI 53209-1104 Ph: (414) 527-5261 |
Samantha Ann Broghammer, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 4600 W Schroeder Dr, Brown Deer, WI 53223 Phone: 414-865-2500 | |
Pasua Chang, MS, RDN, CD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 9460 N Bethanne Dr, Brown Deer, WI 53223 Phone: 414-252-9347 |