Individual
AMANDA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1531 S MADISON ST FL 3, APPLETON, WI 54915-1800
(920) 749-4000
Mailing address
1531 S MADISON ST FL 3, APPLETON, WI 54915-1800
(920) 749-4000
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
APRN11024430
WI
Other
Enumeration date
03/23/2023
Last updated
10/08/2025
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