Individual
AMY LYNN STAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
100 GORE RD, MORRIS, IL 60450-9466
(815) 364-8919
Mailing address
725 SCHOOL ST STE A, MORRIS, IL 60450-1207
(815) 941-9124
(815) 941-4363
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209010035
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209.010035
IL LICENSE
IL
05
—
PENDING
—
IL
Enumeration date
11/26/2012
Last updated
08/07/2024
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