Individual
AMANDA M REDA-GOGLIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
199 COUNTY ROAD DF, JUNEAU, WI 53039
(920) 386-3492
Mailing address
199 COUNTY ROAD DF, JUNEAU, WI 53039-9512
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
8874
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063980845
—
WI
01
—
8874
ADVANCED PRACTICE NURSE PRESCRIBER
WI
Enumeration date
11/09/2018
Last updated
07/31/2020
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