Healthcare Provider Details

I. General information

NPI: 1043161268
Provider Name (Legal Business Name): AMANDA LYNN RUONA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7029 S GERDES RD
MAPLETON IL
61547-9611
US

IV. Provider business mailing address

7029 S GERDES RD
MAPLETON IL
61547-9611
US

V. Phone/Fax

Practice location:
  • Phone: 309-210-5872
  • Fax: 309-326-4399
Mailing address:
  • Phone: 309-210-5872
  • Fax: 309-326-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.034685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: