Individual
AMANDA SUSAN BOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2910 HARLEM AVE, RIVERSIDE, IL 60546-1785
(708) 447-4267
Mailing address
2910 HARLEM AVE, RIVERSIDE, IL 60546-1785
(708) 447-4267
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085006069
IL
Other
Enumeration date
11/02/2016
Last updated
11/02/2016
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