Individual
AMANDA M MAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3225 HEDLEY RD, SPRINGFIELD, IL 62711-6248
(217) 726-7300
(217) 726-5989
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(800) 577-5368
(217) 757-2021
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209016157
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017014688
MHFNP CERTIFICATION
IL
Enumeration date
07/27/2017
Last updated
07/27/2017
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