Provider Demographics
NPI:1639239981
Name:ROBERTS, AMANDA M (RN BSN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 WALTHAM RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-3972
Mailing Address - Country:US
Mailing Address - Phone:608-669-1006
Mailing Address - Fax:
Practice Address - Street 1:2310 WALTHAM RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-3972
Practice Address - Country:US
Practice Address - Phone:608-669-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse