Individual
MS. AMANDA RENEE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-4050
(414) 805-0855
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-4050
(414) 805-0855
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
11297
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538837166
—
WI
Enumeration date
08/30/2021
Last updated
03/23/2023
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