Provider Demographics
NPI:1932491057
Name:PICORD, AMANDA TRAN (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:TRAN
Last Name:PICORD
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 1:6615 S WHITNALL EDGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-1216
Mailing Address - Country:US
Mailing Address - Phone:414-687-3652
Mailing Address - Fax:
Practice Address - Street 1:6615 S WHITNALL EDGE RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-1216
Practice Address - Country:US
Practice Address - Phone:414-687-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170714-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse