Provider Demographics
NPI:1710990304
Name:ZIEGEWEID, AMANDA C (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:ZIEGEWEID
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4321
Mailing Address - Country:US
Mailing Address - Phone:414-805-5320
Mailing Address - Fax:414-805-5323
Practice Address - Street 1:10000 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4321
Practice Address - Country:US
Practice Address - Phone:414-805-5320
Practice Address - Fax:414-805-5323
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2022363AM0700X
TXPA05936363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05936OtherPA LICENSE
WI2022OtherLICENSE
WI2022OtherLICENSE