Healthcare Provider Details

I. General information

NPI: 1578298469
Provider Name (Legal Business Name): AMNA MOUSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 N BELL SCHOOL RD
ROCKFORD IL
61114-6624
US

IV. Provider business mailing address

5468 MAPLELEAF CIR
ROCKFORD IL
61108-8080
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351049989
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: