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General NPI Number Information
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NPI Number | 1053936088
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Entity Type | Individual
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Provider Name | AMANDA LYNN OEDER PA
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Gender | Female
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | N16W24131 RIVERWOOD DR
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City | WAUKESHA
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State | WI
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Zip | 53188-1106
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Country | US
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Telephone | 262-696-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 1902 E BROADWAY APT 420
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City | WAUKESHA
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State | WI
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Zip | 53186-8183
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Country | US
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Telephone | 920-492-9201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5504
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0009263
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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