Healthcare Provider Details

I. General information

NPI: 1851932040
Provider Name (Legal Business Name): AMANDA L MCDONALD APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA L HAMLET APRN, CNP

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SAINT CLARE CT STE 100
WASHINGTON IL
61571-9239
US

IV. Provider business mailing address

128 FIELD GROVE CT
EAST PEORIA IL
61611-4323
US

V. Phone/Fax

Practice location:
  • Phone: 309-886-4000
  • Fax:
Mailing address:
  • Phone: 309-634-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019127
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: