Healthcare Provider Details

I. General information

NPI: 1417370677
Provider Name (Legal Business Name): AMY BURGESS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY BURGESS APN

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 225
AURORA IL
60504-5894
US

IV. Provider business mailing address

1256 WATERFORD SUITE 230
AURORA IL
60504-7206
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4800
  • Fax: 630-978-6791
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-499-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number209.009776
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: