Healthcare Provider Details

I. General information

NPI: 1356888689
Provider Name (Legal Business Name): AMBER J RODRIGUEZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER J MILLIGAN

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE STE 115
AURORA IL
60504-7205
US

IV. Provider business mailing address

2040 OGDEN AVE STE 115
AURORA IL
60504-7205
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-0200
  • Fax: 630-585-7396
Mailing address:
  • Phone: 630-585-0200
  • Fax: 630-585-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015146
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: