Healthcare Provider Details

I. General information

NPI: 1538785407
Provider Name (Legal Business Name): AMANDA L THOMPSON DNP, APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 10-742
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST STE 10-742
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8143
  • Fax: 312-695-4075
Mailing address:
  • Phone: 312-695-8143
  • Fax: 312-695-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209021222
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209021222
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: