MEDICARE: AMANDA ANNE BREEDING FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	041457427	IL

General Provider Information

NPI Number	:	1679437305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ANNE BREEDING FNP-C

Provider Business Mailing Address
First Line	:	2801 W MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-6646
Country	:	US
Telephone Number	:	618-416-2018
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 W MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-6646
Country	:	US
Telephone Number	:	618-416-2018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “ AMANDA ANNE BREEDING FNP-C” Practice Location

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