Individual
AMANDA MCCONVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2901 HUNTERS TRL, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 268-9780
Mailing address
119 PRAIRIE HEIGHTS DR, VERONA, WI 53593-2333
(608) 370-3641
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
15536
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
15536
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100367843
—
WI
Enumeration date
07/12/2024
Last updated
03/27/2026
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