Healthcare Provider Details

I. General information

NPI: 1417997255
Provider Name (Legal Business Name): AMANDA LYNN LABADIE APN/NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LYNN SNYDER APN/NP

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

2704 W BALMORAL AVE
CHICAGO IL
60625-3204
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-3592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209005733
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: