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General NPI Number Information
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NPI Number | 1033925029
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Entity Type | Organization
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Legal Business Name | FULL ACCESS CARE LLC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 610 N GILBERT ST STE A
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City | DANVILLE
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State | IL
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Zip | 61832-3903
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Country | US
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Telephone | 217-213-6241
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Fax | 217-213-6258
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Provider Business Mailing Address
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Address Line | 610 N GILBERT ST STE A
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City | DANVILLE
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State | IL
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Zip | 61832-3903
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Country | US
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Telephone | 217-213-6241
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Fax | 217-213-6258
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | AMANDA SPEZIA
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Credential | FULL AUTHORITY NP
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Telephone | 217-213-6241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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