Provider Demographics
NPI:1477231314
Name:STITTLEBURG, AMANDA LYNN (DNP, APNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:STITTLEBURG
Suffix:
Gender:F
Credentials:DNP, APNP, FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:UDELHOVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1104 21ST ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1156
Mailing Address - Country:US
Mailing Address - Phone:608-768-3900
Mailing Address - Fax:
Practice Address - Street 1:1104 21ST ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1156
Practice Address - Country:US
Practice Address - Phone:608-768-3900
Practice Address - Fax:608-524-1947
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14121-33363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily