# AMANDA DEREMO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922400563
- **Authorized official:** AMANDA DEREMO (EMPLOYER)
- **Authorized official phone:** (608) 449-1399

## Contact information

- **Practice address:** 82 FALLING CREEK CIR, JANESVILLE, WI 53548-9106
- **Practice address phone:** (608) 449-1399
- **Mailing address:** 82 FALLING CREEK CIR, JANESVILLE, WI 53548-9106
- **Mailing address phone:** (608) 449-1399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 318603 | WI | Yes |

## Other

- **Enumeration date:** 09/25/2014
- **Last updated:** 09/25/2014