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General NPI Number Information
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NPI Number | 1396087599
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Entity Type | Individual
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Provider Name | AMANDA NICHOLE KORTE N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 9423 HOLY CROSS LN SUITE 111
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City | BREESE
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State | IL
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Zip | 62230-3510
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Country | US
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Telephone | 618-526-8850
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Fax | 618-526-8852
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Provider Business Mailing Address
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Address Line | 1504 19TH ST
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City | HIGHLAND
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State | IL
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Zip | 62249-2547
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Country | US
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Telephone | 618-779-8336
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Fax |
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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 | 20901339
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License Number State | IL
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