Provider Demographics
NPI:1275874273
Name:MCCORMICK, AMY MARIE (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:SHERRARD
Mailing Address - State:IL
Mailing Address - Zip Code:61281-9317
Mailing Address - Country:US
Mailing Address - Phone:309-716-6878
Mailing Address - Fax:
Practice Address - Street 1:500 W RIVER DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1014
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010286363LP0200X
IAC119377363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics