Individual
MRS. AMANDA JEAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4621 EASTPARK BLVD, MADISON, WI 53718-2000
(608) 915-0100
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
(608) 260-6000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
2394-023
WI
363AS0400X
Surgical Physician Assistant
Primary
2394
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679569024
—
WI
01
—
60959
DEAN HEALTH INSURANCE
WI
Enumeration date
09/21/2005
Last updated
01/30/2026
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