Individual
AMANDA WATERHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
825 LUXOR LANDING RD, GOREVILLE, IL 62939-3296
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041487949
IL
Other
Enumeration date
03/07/2023
Last updated
03/07/2023
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