Individual
MISS AMANDA CATHERINE FRASER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1100 BROADWAY, ROCKFORD, IL 61104-1429
(815) 490-1600
Mailing address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(508) 649-2917
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.010647
IL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
06/17/2024
Last updated
10/30/2025
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