Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 041303590 | IL |
NPI | 1043533540 |
---|---|
Provider Name | Amanda K Boitnott |
First Address | Normal, IL 61761-3551 |
Second Address | Normal, IL 61761-3551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2010 |
Last Update Date | 10/07/2013 |