Healthcare Provider Details

I. General information

NPI: 1093266108
Provider Name (Legal Business Name): AMANDA GILMOUR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA NEUDORF NP

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8914 N KNOXVILLE AVE
PEORIA IL
61615-1410
US

IV. Provider business mailing address

2535 E WASHINGTON ST
EAST PEORIA IL
61611-1863
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-9110
  • Fax:
Mailing address:
  • Phone: 309-694-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: