Most Relevant Information
Provider Data
| NPI Number: | 1003520495 |
| Provider Name: | AMANDA ROSE BANTLE APNP |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 168768-30 |
Most Important Dates
| Enumeration Date: | 01/10/2023 |
| Last Updated: | 01/31/2023 |
Provider Practice Location
2581 DEVELOPMENT DR
GREEN BAY
WI
543114247
Practice Location Phone/Fax
| Phone: | 9203470400 |
| Fax: |
Provider Mailing Location
1035 KEPLER DR
GREEN BAY
WI
543118320
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |