Provider Demographics
NPI:1497195077
Name:MUEHLBAUER, AMANDA L (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:MUEHLBAUER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W985 HACKER RD APT 5
Mailing Address - Street 2:
Mailing Address - City:BRILLION
Mailing Address - State:WI
Mailing Address - Zip Code:54110-9158
Mailing Address - Country:US
Mailing Address - Phone:920-810-1792
Mailing Address - Fax:
Practice Address - Street 1:W985 HACKER RD APT 5
Practice Address - Street 2:
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-9158
Practice Address - Country:US
Practice Address - Phone:920-810-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI195909 - 30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse