Provider Demographics
NPI:1225676992
Name:POWELL, AMANDA JEAN (RN, APN, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:POWELL
Suffix:
Gender:F
Credentials:RN, APN, FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:FRASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2052 TUNBRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6024
Mailing Address - Country:US
Mailing Address - Phone:847-987-9883
Mailing Address - Fax:
Practice Address - Street 1:1555 BARRINGTON RD STE 210
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1063
Practice Address - Country:US
Practice Address - Phone:847-885-3500
Practice Address - Fax:847-285-1871
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019854363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner