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NPI Code Detail

MEDICARE: MRS. AMANDA REDIGER

MEDICARE: MRS. AMANDA REDIGER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner209025356IL

General Provider Information

NPI Number : 1184356958
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA REDIGER
Provider Business Mailing Address
First Line : 110 N BURR BLVD
Second Line :
City : KEWANEE
State : IL
Zip : 61443-2214
Country : US
Telephone Number : 309-852-0197
Fax Number :
Provider Business Practice Location Address
First Line : 110 N BURR BLVD
Second Line :
City : KEWANEE
State : IL
Zip : 61443-2214
Country : US
Telephone Number : 309-852-0197
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2022
Last Update Date : 06/29/2022

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Directions to “ MRS. AMANDA REDIGER ” Practice Location

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