Provider Demographics
NPI:1376829010
Name:ALLEN, AMANDA MARIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 W ALTA RD
Mailing Address - Street 2:APT. 1904
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1279
Mailing Address - Country:US
Mailing Address - Phone:219-508-5791
Mailing Address - Fax:
Practice Address - Street 1:8600 N STATE ROUTE 91
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9541
Practice Address - Country:US
Practice Address - Phone:309-691-6616
Practice Address - Fax:309-691-2943
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant