Healthcare Provider Details

I. General information

NPI: 1063384386
Provider Name (Legal Business Name): AMANDA LEE SCHMIDT BSN, APNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MADISON AVE
FORT ATKINSON WI
53538-1444
US

IV. Provider business mailing address

N5404 COUNTY ROAD Q
JEFFERSON WI
53549-9431
US

V. Phone/Fax

Practice location:
  • Phone: 920-541-3078
  • Fax:
Mailing address:
  • Phone: 920-723-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17441-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: