Healthcare Provider Details

I. General information

NPI: 1982968285
Provider Name (Legal Business Name): AMANDA BRIELLE FIGGE RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BRIELLE NOVY RD, LDN

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E CARPENTER ST
SPRINGFIELD IL
62702-5185
US

IV. Provider business mailing address

320 E CARPENTER ST
SPRINGFIELD IL
62702-5185
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3948
  • Fax: 217-527-3209
Mailing address:
  • Phone: 217-788-3948
  • Fax: 217-527-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164005737
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: