Healthcare Provider Details

I. General information

NPI: 1932866761
Provider Name (Legal Business Name): AMANDA LEE GEOFFROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA LEE TRAGO

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER
MADISON WI
53705-2254
US

IV. Provider business mailing address

1428 WINNEBAGO CIR
BARABOO WI
53913-1296
US

V. Phone/Fax

Practice location:
  • Phone: 86-356-9318
  • Fax:
Mailing address:
  • Phone: 608-415-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number246320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: