Provider Demographics
NPI:1396192100
Name:KREBSBACH, AMANDA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KREBSBACH
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 WESTVIEW CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-3071
Mailing Address - Country:US
Mailing Address - Phone:715-613-0556
Mailing Address - Fax:
Practice Address - Street 1:1035 WESTVIEW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-3071
Practice Address - Country:US
Practice Address - Phone:715-613-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-22
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI199164-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1802-028OtherADULT AND PEDIATRIC VENTILATOR CERTIFIED