Individual
AMANDA REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1006 S DIVISION ST, CARTERVILLE, IL 62918-1539
(618) 519-9200
Mailing address
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL 62918-0577
(618) 985-8221
(618) 985-4635
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209012925
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209012925
LICENSE
IL
Enumeration date
07/16/2015
Last updated
12/11/2020
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