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General NPI Number Information
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NPI Number | 1528899796
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Entity Type | Organization
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Legal Business Name | AMV MEDICAL LLC
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 1406 S CHESTNUT DR
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-4520
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Country | US
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Telephone | 708-320-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 2440 S LARAMIE AVE UNIT 50646
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City | CICERO
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State | IL
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Zip | 60804-5147
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMANDA VILLAGOMEZ
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Credential | FNP-BC
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Telephone | 708-320-1510
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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 |
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License Number State |
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