Individual
AMY L. GOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3440
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-007198
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538177241 1
—
IL
01
—
IL2613
MEDICARE GROUP PTAN
IL
01
—
IL2613050
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
08/25/2008
Last updated
03/01/2023
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