Individual
AMBER DUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
2512 HURST DR, MATTOON, IL 61938-9200
(217) 258-5900
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209022958
IL
Other
Enumeration date
09/07/2021
Last updated
11/23/2021
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