Individual
AMANDA LYNN HALVORSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5970 CHURCHVIEW DR, ROCKFORD, IL 61107-2574
(815) 971-2000
Mailing address
3456 N FARWELL BRIDGE RD, ROCK CITY, IL 61070-9783
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
209016873
IL
363L00000X
Nurse Practitioner
Primary
209016873
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891294195
—
WI
Enumeration date
02/02/2018
Last updated
08/31/2020
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