Healthcare Provider Details

I. General information

NPI: 1093976169
Provider Name (Legal Business Name): AMANDA YOUMANS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2008
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 E SENECA PL
PEORIA IL
61603
US

IV. Provider business mailing address

PO BOX 940
MORRIS IL
60450-0940
US

V. Phone/Fax

Practice location:
  • Phone: 309-669-2000
  • Fax:
Mailing address:
  • Phone: 815-416-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number036125159
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number125052610
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: