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General NPI Number Information
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NPI Number | 1134993967
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Entity Type | Individual
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Provider Name | MRS. AMANDA MARIE KUBIS
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Gender | Female
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 2 INDUSTRIAL PARK RD
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City | MONMOUTH
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State | IL
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Zip | 61462-9698
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Country | US
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Telephone | 309-734-9376
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Fax | 309-734-5338
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Provider Business Mailing Address
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Address Line | 2 INDUSTRIAL PARK RD
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City | MONMOUTH
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State | IL
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Zip | 61462-9698
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Country | US
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Telephone | 309-734-9376
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Fax | 309-734-5338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 209-028929
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License Number State | IL
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