Individual
AMANDA JO LANHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10000 W BLUEMOUND RD, WAUWATOSA, WI 53226-4321
(414) 454-8000
(414) 805-3808
Mailing address
10000 W BLUEMOUND RD, WAUWATOSA, WI 53226-4321
(414) 454-8000
(414) 805-3808
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4686
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417402058
—
WI
Enumeration date
08/24/2016
Last updated
07/26/2022
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