Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 209021173 | IL |
NPI | 1013536804 |
---|---|
Provider Name | Amy N Mann |
First Address | Taylorville, IL 62568-8950 |
Second Address | Springfield, IL 62702-3749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2020 |
Last Update Date | 26/05/2020 |