=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245190735
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA ANN WILSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2025
-----------------------------------------------------
Last Update Date | 11/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 TYLER RD S STE 126
-----------------------------------------------------
City | RED WING
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55066-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-372-4170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 6TH AVE NE
-----------------------------------------------------
City | KASSON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55944-1578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-281-8810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 2993
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------