Individual
AMANDA JO LANHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1610 HOOVER ST, NEW HOLSTEIN, WI 53061-1636
(872) 231-3162
Mailing address
PO BOX 74008272, CHICAGO, IL 60674-8272
(872) 231-3162
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
05/28/2026
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