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Individual provider Active NPI

Amanda Wallace, APRN

  • Obstetrics & Gynecology Physician
  • Appleton, WI
National Provider Identifier
1992408587
Registry record updated Oct 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
APRN11024430 Issued in WI
Practice address
1531 S Madison St FL 3
Appleton, WI 54915-1800
Phone
(920) 749-4000
NPI assigned
Mar 23, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X APRN11024430 WI Primary

Addresses

Primary practice location

1531 S Madison St FL 3
Appleton, WI 54915-1800

Mailing address

1531 S Madison St FL 3
Appleton, WI 54915-1800
Phone (920) 749-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230420003066 FL Practitioner - Nurse Practitioner 1153786421
I20231114002785 WI Practitioner - Nurse Practitioner 1153786421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Womens Health Specialists SCGroup PAC ID 8628044138, 27 clinicians

Practice addresses (Care Compare)

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 749-4000

Hospital & facility affiliations

  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Ascension NE Wisconsin - St Elizabeth Campus Hospital, Appleton, WI, CCN 520009
  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN11024430WIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Women'S Health Specialists, S.C. Obstetrics & Gynecology CurrentSince Nov 2, 2023 Accepting new patients
Sacred Heart Health System, Inc. Current Accepting new patients

Locations

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

1818 N Meade St
Ste 330
Appleton, WI 54911
Phone (920) 749-4000

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

1531 S Madison St
Fl 3
Appleton, WI 54915
Phone (920) 730-4413

Organizations & group practices 2

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1679529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759881600000",
    "number": "1992408587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 S MADISON ST FL 3",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151800",
            "telephone_number": "920-749-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 S MADISON ST FL 3",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151800",
            "telephone_number": "920-749-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-23",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "APRN11024430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.