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NPI Code Detail

MEDICARE: MRS. AMANDA JEAN JOHNSON PA-C

MEDICARE: MRS. AMANDA JEAN JOHNSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant2394WI
2363AM0700XMedical Physician Assistant2394-023WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
260959OTHERWIDEAN HEALTH INSURANCE

General Provider Information

NPI Number : 1679569024
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA JEAN JOHNSON PA-C
Provider Business Mailing Address
First Line : 7974 UW HEALTH CT
Second Line :
City : MIDDLETON
State : WI
Zip : 53562-5531
Country : US
Telephone Number : 608-260-6000
Fax Number :
Provider Business Practice Location Address
First Line : 4621 EASTPARK BLVD
Second Line :
City : MADISON
State : WI
Zip : 53718-2000
Country : US
Telephone Number : 608-915-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 01/30/2026

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