Individual
MYA AMALIE LONNEBOTN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 HIGHLAND AVE, MADISON, WI 53792-9567
(608) 263-4757
(608) 890-7407
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
8021
WI
Other
Enumeration date
07/01/2022
Last updated
12/18/2024
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