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NPI Code Detail

MEDICARE: AMY MCLAIN APN

MEDICARE: AMY MCLAIN APN
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 Practitioner209015064IL

General Provider Information

NPI Number : 1487197034
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MCLAIN APN
Provider Business Mailing Address
First Line : 3051 HOLLIS DR
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-7450
Country : US
Telephone Number : 217-492-9695
Fax Number :
Provider Business Practice Location Address
First Line : 4965 E LOST BRIDGE RD
Second Line :
City : DECATUR
State : IL
Zip : 62521-5139
Country : US
Telephone Number : 217-864-5531
Fax Number : 217-864-2449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2016
Last Update Date : 08/19/2022

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