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General NPI Number Information
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NPI Number | 1891607339
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Entity Type | Individual
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Provider Name | AMANDA WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 4 MEMORIAL DR STE 130
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City | ALTON
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State | IL
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Zip | 62002-6704
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Country | US
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Telephone | 618-463-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 1737 REDBIRD CV
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City | SAINT LOUIS
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State | MO
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Zip | 63144-1610
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Country | US
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Telephone | 217-720-0160
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2021025542
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License Number State | MO
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