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Individual

AMANDA PASSINT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
411 PEWAUKEE RD, PEWAUKEE, WI 53072-5886
(262) 695-5145
Mailing address
W224N2824 STONEWOOD CT, WAUKESHA, WI 53186-1042

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
363L00000X
WI
363LP0200X
Pediatric Nurse Practitioner
20082701
WI

Other

Enumeration date
07/01/2014
Last updated
07/01/2014
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