Individual
AMANDA MUNDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
225000 HUMMINGBIRD RD, WAUSAU, WI 54401-2948
(316) 300-0955
Mailing address
225000 HUMMINGBIRD RD, WAUSAU, WI 54401-2948
(316) 300-0955
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4817-23
WI
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201088930E
—
KS
Enumeration date
12/06/2013
Last updated
06/17/2021
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