Individual
AMANDA R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
3916 N INTERTECH CT, APPLETON, WI 54913-6957
(920) 996-1000
Mailing address
3916 N INTERTECH CT, APPLETON, WI 54913-6957
(920) 996-1000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3318-33
WI
363LF0000X
Family Nurse Practitioner
3318-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306010004
—
WI
Enumeration date
04/15/2008
Last updated
03/07/2022
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