Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mya Amalie Lonnebotn

Individual provider Surgical Physician Assistant · NPI 1982337432

Mya Amalie Lonnebotn is a Physician Assistant in Madison, Wisconsin. Graduated from University of Wisconsin School of Medicine in 2024, 2 years ago. Practices with University of Wisconsin Medical Foundation Inc, a 2,536-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Wisconsin.

Years since qualifying
2
Trained at
University of Wisconsin School of Medicine
Licensed in
WI
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

4621 Eastpark Blvd
Madison, WI 53718-2000
Phone: (608) 914-0800
Fax: (608) 265-1726
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 8021-23 (WI)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 8021 (WI)

Record details

NPI number1982337432
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 1, 2022
Last updated in NPPESJuly 15, 2026
Certification dateJuly 15, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolUNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
Graduated 2024 (2 years in practice)
Group practice University Of Wisconsin Medical Foundation Inc — 2536 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations18 on file with Medicare

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