Provider Demographics
NPI:1992250112
Name:KAFKA, AMANDA E (APNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:KAFKA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:10 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1239
Mailing Address - Country:US
Mailing Address - Phone:608-825-3500
Mailing Address - Fax:608-825-3786
Practice Address - Street 1:10 TOWER DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1239
Practice Address - Country:US
Practice Address - Phone:608-825-3500
Practice Address - Fax:608-825-3786
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7083-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992250112Medicaid
WI1992250112Medicaid
WIK400326116Medicare PIN