Individual
AMANDA SUE BURGESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 SAINT ELIZABETH BLVD, O FALLON, IL 62269-1099
(618) 234-2120
(618) 641-5810
Mailing address
1 SAINT ELIZABETH BLVD, O FALLON, IL 62269-1099
(618) 234-2120
(618) 641-5810
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
041448788
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209021562
IL
Other
Enumeration date
05/07/2020
Last updated
07/07/2020
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