Healthcare Provider Details

I. General information

NPI: 1093768871
Provider Name (Legal Business Name): AMANDA M KOTOWSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA M SCHNEIDER NP

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 S MOORLAND RD 3RD FLOOR
NEW BERLIN WI
53151-7494
US

IV. Provider business mailing address

9000 W WISCONSIN AVE MS 958
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 262-432-7599
  • Fax: 262-432-7694
Mailing address:
  • Phone: 414-266-7615
  • Fax: 414-266-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2644
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: