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General NPI Number Information
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NPI Number | 1417771692
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Entity Type | Individual
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Provider Name | AMANDA R WEBER PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 322 S BUCHANAN ST
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-2086
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Country | US
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Telephone | 618-967-0518
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Fax | 618-417-6049
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Provider Business Mailing Address
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Address Line | 6856 MIDDLEGATE LN
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City | GLEN CARBON
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State | IL
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Zip | 62034-4053
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Country | US
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Telephone | 314-570-8866
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209031040
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License Number State | IL
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