Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209021666 | IL |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 309016356 | IL |
NPI | 1144822396 |
---|---|
Provider Name | Amanda Marie Greear |
First Address | Homer Glen, IL 60491-8145 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2020 |
Last Update Date | 18/11/2020 |