Healthcare Provider Details

I. General information

NPI: 1104408418
Provider Name (Legal Business Name): AMANDA ELIZABETH MUELLER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA ELIZABETH PEREZ FNP-BC

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD STE 610
ELK GROVE VILLAGE IL
60007-3362
US

IV. Provider business mailing address

800 BIESTERFIELD RD STE 610
ELK GROVE VILLAGE IL
60007-3362
US

V. Phone/Fax

Practice location:
  • Phone: 847-981-3630
  • Fax:
Mailing address:
  • Phone: 847-981-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023282
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209023282
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: