Healthcare Provider Details

I. General information

NPI: 1841083342
Provider Name (Legal Business Name): AMANDA EMILY CASTELLANOS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HENRY LUCKOW LN
BELVIDERE IL
61008-1702
US

IV. Provider business mailing address

1700 HENRY LUCKOW LN
BELVIDERE IL
61008-1702
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-8650
  • Fax:
Mailing address:
  • Phone: 779-696-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberXYXZ06973
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: