Provider Demographics
NPI:1518921022
Name:NICOLAIZANDER, AMARA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:AMARA
Middle Name:ANN
Last Name:NICOLAIZANDER
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 1:285 COUNTY ROAD MM
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:WI
Mailing Address - Zip Code:53521-9491
Mailing Address - Country:US
Mailing Address - Phone:608-455-1634
Mailing Address - Fax:
Practice Address - Street 1:285 COUNTY ROAD MM
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:WI
Practice Address - Zip Code:53521-9491
Practice Address - Country:US
Practice Address - Phone:608-455-1634
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI88740-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39873200OtherINDEPENDENT PROVIDER