Healthcare Provider Details

I. General information

NPI: 1205485364
Provider Name (Legal Business Name): KAMI MAURER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 W CEDAR HILLS DR
DUNLAP IL
61525-9760
US

IV. Provider business mailing address

3911 W CEDAR HILLS DR
DUNLAP IL
61525
US

V. Phone/Fax

Practice location:
  • Phone: 929-650-3990
  • Fax:
Mailing address:
  • Phone: 309-219-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11024933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: