Individual
AMANDA LOUISE GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7725 N KNOXVILLE AVE, PEORIA, IL 61614-2079
(309) 495-0240
Mailing address
7725 N KNOXVILLE AVE, PEORIA, IL 61614-2079
(309) 495-0240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.024570
IL
Other
Enumeration date
01/03/2022
Last updated
09/26/2022
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