Provider Demographics
NPI:1720322522
Name:AMSTADT, VALERIE B (PAC)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:B
Last Name:AMSTADT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:B
Other - Last Name:ZANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:6601 STONE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6183
Mailing Address - Country:US
Mailing Address - Phone:920-296-4306
Mailing Address - Fax:
Practice Address - Street 1:530 RUNNING W DR # 120
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-2074
Practice Address - Country:US
Practice Address - Phone:920-296-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3037363A00000X
WYPA611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1619861671OtherGROUP NPI
WI68086 2607Medicare PIN
WI1720322522Medicaid