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General NPI Number Information
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NPI Number | 1407528987
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Entity Type | Individual
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Provider Name | AMBER M. ALTIDOR DNP, APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2021
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 2501 CHATHAM RD STE 4134
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City | SPRINGFIELD
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State | IL
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Zip | 62704-6270
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Country | US
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Telephone | 773-716-3478
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Fax | 618-822-4030
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM ROAD SUITE 4134
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City | SPRINGFIELD
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State | IL
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Zip | 62704-5746
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Country | US
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Telephone | 773-716-3478
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Fax | 618-822-4030
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209024124
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License Number State | IL
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