Individual
MRS. AMANDA C DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9570 W 159TH ST, ORLAND PARK, IL 60467-5504
(708) 675-7070
(708) 675-7074
Mailing address
PO BOX 544, DEPT 5390, MILWAUKEE, WI 53201-0544
(815) 713-2600
(815) 654-8020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003583
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204591
GROUP PTAN
IL
01
—
213992
GROUP PTAN
IL
Enumeration date
09/17/2009
Last updated
03/03/2021
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