Individual
AMANDA BLACKTHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6881
Mailing address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6881
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6642
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750750931
—
WI
Enumeration date
09/17/2015
Last updated
03/01/2022
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