Amanda Lee Suino-Malcolm, APRN, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5436-33 Issued in WI

Practice address

13447 W County Road B
Hayward, WI 54843-2259

Phone

(715) 558-7883

Fax

(715) 558-7348

NPI assigned

Apr 3, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Amanda Lee Shober Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lac Courte Oreilles Governing BoardGroup PAC ID 7810983517, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tamarack Health Hayward Medical Center Hospital, Hayward, WI, CCN 521336

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lac Courte Oreilles Governing

  • Clinic/Center
  • Hayward, WI
  • NPI 1194830208

  Family

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Medical Services, Inc

  • Critical Access Hospital
  • Hayward, WI
  • NPI 1912992827
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1356684880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13447 W COUNTY ROAD B",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548432259",
            "telephone_number": "715-558-7883",
            "fax_number": "715-558-7348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13447 W COUNTY ROAD B",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548432259",
            "telephone_number": "715-558-7883",
            "fax_number": "715-558-7348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUINO-MALCOLM",
        "first_name": "AMANDA",
        "middle_name": "LEE",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-03",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "141483-30",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "5436-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356684880",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "SHOBER",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Suzanne Sterling-Bowen, MSW, APSW
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• James R Strunk, RPH
• Krista Lee Strunk, REGISTERED NURSE
• Dianne Lynn Sullivan, CSAC
• Franklin G Suo, R.PH.
• Superior Counseling, LLC
• Jessica Swanson, MD
• Randi L Swanson

• Family Nurse Practitioner in Hayward, WI
• Providers in Hayward, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.