Individual
MRS. AMANDA J OHNESORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
105 S LOCUST, TREMONT, IL 61568-0187
(309) 925-2961
(309) 925-4221
Mailing address
105 S LOCUST, PO BOX 187, TREMONT, IL 61568-0187
(309) 925-2961
(309) 925-4221
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.004072
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01004753
RR MEDICARE
IL
Enumeration date
08/03/2011
Last updated
03/19/2012
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