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NPI Code Detail

MEDICARE: AMANDA JO SHARP RN

MEDICARE: AMANDA JO SHARP RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP2201XAmbulatory Care Registered Nurse250902WI

General Provider Information

NPI Number : 1649107269
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA JO SHARP RN
Provider Business Mailing Address
First Line : W11185 HAGEN LN
Second Line :
City : BLACK RIVER FALLS
State : WI
Zip : 54615-5994
Country : US
Telephone Number : 608-372-3971
Fax Number :
Provider Business Practice Location Address
First Line : 500 E VETERANS ST
Second Line :
City : TOMAH
State : WI
Zip : 54660-3105
Country : US
Telephone Number : 608-372-3971
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2026
Last Update Date : 05/07/2026

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