Healthcare Provider Details

I. General information

NPI: 1790390797
Provider Name (Legal Business Name): AMANDA J LEMAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 NEAL AVE
JOLIET IL
60433-2548
US

IV. Provider business mailing address

12964 BRADFORD LN
PLAINFIELD IL
60585-2106
US

V. Phone/Fax

Practice location:
  • Phone: 815-727-8670
  • Fax:
Mailing address:
  • Phone: 630-697-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021746
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: