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General NPI Number Information
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NPI Number | 1447079546
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Entity Type | Individual
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Provider Name | AMANDA ACOSTA APRN, CNM, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 2909 N MAIN ST
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City | ROCKFORD
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State | IL
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Zip | 61103-3100
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Country | US
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Telephone | 779-696-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 2576 BIBURY DR
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City | ROCKFORD
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State | IL
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Zip | 61109-5003
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Country | US
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Telephone | 815-505-3263
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 209.030377
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License Number State | IL
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