Provider Demographics
NPI:1376228981
Name:BARTELS, AMANDA LYNE (APNP)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LYNE
Last Name:BARTELS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 W LARABEE ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1718
Mailing Address - Country:US
Mailing Address - Phone:262-355-5507
Mailing Address - Fax:
Practice Address - Street 1:8153 S 27TH ST STE 600
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9557
Practice Address - Country:US
Practice Address - Phone:414-761-1802
Practice Address - Fax:414-301-9101
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14106363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily