Individual provider · Type 1 NPI

Mya Amalie Lonnebotn

Medical Physician Assistant · Madison, WI

NPI number 1982337432 Active

Practice location

4621 Eastpark Blvd
Madison, WI 53718-2000

Call (608) 914-0800 Map

Fax (608) 265-1726

Mailing address

7974 Uw Health Ct
Middleton, WI 53562-5531

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant 363AS0400X8021 (WI)
Medical Physician Assistant Primary 363AM0700X8021-23 (WI)

Medical Physician Assistant: Definition to come...

35 other providers at this address

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About NPI 1982337432

Mya Amalie Lonnebotn's National Provider Identifier is 1982337432, issued on Jul 1, 2022. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Madison, WI. The record was last updated on Jul 15, 2026.