Provider Demographics
NPI:1174025357
Name:DURST, AMY M (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:DURST
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST STE 500A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-2038
Mailing Address - Country:US
Mailing Address - Phone:309-672-4980
Mailing Address - Fax:309-671-2979
Practice Address - Street 1:1001 MAIN ST STE 500A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606
Practice Address - Country:US
Practice Address - Phone:309-672-4980
Practice Address - Fax:309-671-2979
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017288363LF0000X
IL209.017288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1174025357OtherNPI