Individual
AMY E WITKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4600 MEMORIAL DR STE 120, BELLEVILLE, IL 62226-5359
(618) 222-1020
Mailing address
4600 MEMORIAL DR STE 120, BELLEVILLE, IL 62226-5359
(618) 222-1020
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209013270
IL
363LF0000X
Family Nurse Practitioner
209013270
IL
Other
Enumeration date
09/10/2015
Last updated
02/08/2022
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