Individual
AMANDA NICOLE PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
964 W RYAN ST, BRILLION, WI 54110-1076
(920) 756-2055
(920) 756-3350
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5094
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1172171
NATIONAL COMMISSION ON CERTIFIED PHYSICIAN ASSISTANTS
—
Enumeration date
03/03/2020
Last updated
01/03/2023
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