Provider Demographics
NPI:1144606096
Name:FULL, AMANDA (DVM, DACVIM)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:FULL
Suffix:
Gender:F
Credentials:DVM, DACVIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5170
Mailing Address - Country:US
Mailing Address - Phone:773-516-5800
Mailing Address - Fax:
Practice Address - Street 1:3927 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5170
Practice Address - Country:US
Practice Address - Phone:773-516-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090010353174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian