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Individual

AMANDA M NELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
403 STAGELINE RD, HUDSON, WI 54016-7848
(715) 531-6800
(715) 531-6801
Mailing address
403 STAGELINE RD, HUDSON, WI 54016-7848
(715) 531-6800
(715) 531-6801

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
WI

Other

Enumeration date
09/01/2009
Last updated
09/01/2009
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