Provider Demographics
NPI:1154919769
Name:RODRIGUEZ, AMANDA ELIZABETH (APNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:BEHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2594 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-5266
Mailing Address - Country:US
Mailing Address - Phone:920-579-0424
Mailing Address - Fax:
Practice Address - Street 1:900 E GRANT ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3487
Practice Address - Country:US
Practice Address - Phone:920-831-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10410363L00000X
WI10410-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily