Healthcare Provider Details

I. General information

NPI: 1588083844
Provider Name (Legal Business Name): AMANDA SPEZIA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
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 TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number277002760
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011231
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: