Individual
AMANDA KATHRYN PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
900 MAIN ST, PEORIA, IL 61602-1005
(309) 672-4908
Mailing address
900 MAIN ST, PEORIA, IL 61602-1005
(309) 672-4908
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-004389
IL
Other
Enumeration date
08/08/2012
Last updated
08/08/2012
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