Individual
AMY JO FUGATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
1000 PALM AVE, MATTOON, IL 61938-6031
(888) 365-6271
Mailing address
15730 N STATE HIGHWAY 130, NEWTON, IL 62448-3273
(217) 663-5414
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
209021558
IL
Other
Enumeration date
07/09/2020
Last updated
01/16/2024
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