NPIMap

Individual provider Active NPI

Amanda Rose Landolt, FNP-C

  • Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1649007469
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
15732-33 Issued in WI
Practice address
2502 S Ashland Ave
Green Bay, WI 54304-5252
Phone
(920) 496-4700
NPI assigned
Sep 16, 2024
Last updated
Dec 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 15732-33 WI Primary

Addresses

Primary practice location

2502 S Ashland Ave
Green Bay, WI 54304-5252

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

Other practice location 1

2793 Lineville Rd
Green Bay, WI 54313-7152
Phone (920) 496-4700

Other identifiers 1

IdentifierTypeStateIssuer
100292996MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address alandolt94691@ewd.direct.hshs.org Direct St Vincent Hospital-Hospital Sisters-Third Order of St Francis

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241024002743 WI Practitioner - Nurse Practitioner 0042743320 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2502 S Ashland Ave
Green Bay, WI 54304-5252
Phone (920) 496-4700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
15732-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Clinic, Inc. CurrentSince Oct 1, 2024 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Oct 1, 2024 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis Nurse Practitioner CurrentSince Oct 1, 2024 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Current Accepting new patients
Prevea Clinic, Inc. CurrentSince Oct 1, 2024 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Oct 1, 2024 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Oct 1, 2024 Accepting new patients

Locations

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

2502 S Ashland Ave
Green Bay, WI 54304
Phone (920) 496-4750

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

2793 Lineville Rd
Howard, WI 54313

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Interoperability endpoints

  • Direct secure messaging: alandolt94691@ewd.direct.hshs.org

Organizations & group practices 7

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

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1726444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1649007469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 S ASHLAND AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045252",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2793 Lineville Rd",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543137152",
            "country_code": "US",
            "telephone_number": "920-496-4700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDOLT",
        "first_name": "AMANDA",
        "middle_name": "ROSE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "15732-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100292996",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alandolt94691@ewd.direct.hshs.org",
            "affiliation": "Y",
            "affiliationName": "St Vincent Hospital-Hospital Sisters-Third Order of St Francis",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2502 S Ashland Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543045252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.