Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5496-12 | WI |
NPI | 1073146650 |
---|---|
Provider Name | Mrs. Amanda M Mathwig |
First Address | Green Bay, WI 54313-3216 |
Second Address | Green Bay, WI 54313-3216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2020 |
Last Update Date | 21/02/2020 |