Individual
AMANDA LEIGH STOVALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5208 N WEAVERRIDGE BLVD, PEORIA, IL 61615-8984
(502) 418-2991
Mailing address
5208 N WEAVERRIDGE BLVD, PEORIA, IL 61615-8984
(502) 418-2991
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036.157682
IL
390200000X
Student in an Organized Health Care Education/Training Program
APPLIED FOR
IN
Other
Enumeration date
04/02/2015
Last updated
01/21/2025
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