Healthcare Provider Details

I. General information

NPI: 1770844060
Provider Name (Legal Business Name): AMY MELISSA BATISTA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2012
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SPALDING DR SUITE 308
NAPERVILLE IL
60540-6508
US

IV. Provider business mailing address

120 SPALDING DR SUITE 308
NAPERVILLE IL
60540-6508
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-7730
  • Fax: 630-527-7732
Mailing address:
  • Phone: 630-527-7730
  • Fax: 630-527-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.013049
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2012016691
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: