Provider Demographics
NPI:1215207337
Name:SELL, AMANDA F (PA-C)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:F
Last Name:SELL
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 1:4225 W. OAKWOOD PARK COURT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2843
Mailing Address - Country:US
Mailing Address - Phone:414-435-0025
Mailing Address - Fax:414-435-0026
Practice Address - Street 1:4225 W OAKWOOD PARK CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8131
Practice Address - Country:US
Practice Address - Phone:414-435-0025
Practice Address - Fax:414-435-0026
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2883363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI288323OtherSTATE
WI100030190Medicaid