Healthcare Provider Details

I. General information

NPI: 1649107269
Provider Name (Legal Business Name): AMANDA JO SHARP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS ST
TOMAH WI
54660-3105
US

IV. Provider business mailing address

W11185 HAGEN LN
BLACK RIVER FALLS WI
54615-5994
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-3971
  • Fax:
Mailing address:
  • Phone: 608-372-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number250902
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: