Provider Demographics
NPI:1720787237
Name:WOLLSCHLAGER, AMANDA SUE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:WOLLSCHLAGER
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 1ST ST E STE 5
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1764
Mailing Address - Country:US
Mailing Address - Phone:320-321-9599
Mailing Address - Fax:877-962-3624
Practice Address - Street 1:1011 1ST ST E STE 5
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1764
Practice Address - Country:US
Practice Address - Phone:320-321-9599
Practice Address - Fax:877-962-3624
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9976363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health