Individual
AMANDA JUNE BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP -BC
Contact information
Practice address
3986 MARYVILLE RD, GRANITE CITY, IL 62040-4191
(618) 797-0618
Mailing address
3986 MARYVILLE RD, GRANITE CITY, IL 62040-4191
(618) 797-0618
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209025025
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811087604
NPI
—
Enumeration date
04/12/2022
Last updated
04/12/2022
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