Healthcare Provider Details

I. General information

NPI: 1033925029
Provider Name (Legal Business Name): FULL ACCESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N GILBERT ST STE A
DANVILLE IL
61832-3903
US

IV. Provider business mailing address

610 N GILBERT ST STE A
DANVILLE IL
61832-3903
US

V. Phone/Fax

Practice location:
  • Phone: 217-213-6241
  • Fax: 217-213-6258
Mailing address:
  • Phone: 217-213-6241
  • Fax: 217-213-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SPEZIA
Title or Position: BUSINESS OWNER
Credential: FULL AUTHORITY NP
Phone: 217-213-6241