Healthcare Provider Details

I. General information

NPI: 1194458976
Provider Name (Legal Business Name): ECHO AMANDA RENEE REDMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 KLEEMANN DR
CLINTON IL
61727-2635
US

IV. Provider business mailing address

919 N GEORGE ST
CLINTON IL
61727-1122
US

V. Phone/Fax

Practice location:
  • Phone: 217-935-5022
  • Fax: 217-935-7692
Mailing address:
  • Phone: 217-433-3969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.413640
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.025730
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: