Healthcare Provider Details

I. General information

NPI: 1861702532
Provider Name (Legal Business Name): AMANDA K KRUTKE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA K KRUTKE

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 LINCOLN ST
CHENOA IL
61726-1283
US

IV. Provider business mailing address

918 LINCOLN ST
CHENOA IL
61726-1283
US

V. Phone/Fax

Practice location:
  • Phone: 815-945-2261
  • Fax:
Mailing address:
  • Phone: 815-945-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number277001882
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209026101
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: