Individual
AMANDA CHRISTINE MIKLAVCIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP PNP-AC
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-3026
(309) 624-2277
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 671-3447
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN.CNP.026647
OH
363LP0200X
Pediatric Nurse Practitioner
Primary
209026119
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/15/2019
Last updated
01/31/2024
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