Provider Demographics
NPI:1033887112
Name:HADDAD, AMANDA (DNP, NNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HADDAD
Suffix:
Gender:F
Credentials:DNP, NNP-BC, APRN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:JURCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3879 HICKORY HILL PKWY W
Mailing Address - Street 2:
Mailing Address - City:HUBERTUS
Mailing Address - State:WI
Mailing Address - Zip Code:53033-9561
Mailing Address - Country:US
Mailing Address - Phone:262-719-7872
Mailing Address - Fax:
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6820
Practice Address - Fax:414-266-6979
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11195-33363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033887112Medicaid