Healthcare Provider Details

I. General information

NPI: 1912229253
Provider Name (Legal Business Name): AMANDA MARIE MCCURDY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 VALLEY VIEW DR
MOLINE IL
61265-6138
US

IV. Provider business mailing address

320 SWANK ST
GALVA IL
61434-8952
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-5560
  • Fax:
Mailing address:
  • Phone: 309-883-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209013586
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number121881
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: