Provider Demographics
NPI:1417370677
Name:BURGESS, AMY (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:1256 WATERFORD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7206
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-499-2399
Practice Address - Street 1:2020 OGDEN AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5894
Practice Address - Country:US
Practice Address - Phone:630-978-4800
Practice Address - Fax:630-978-6791
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009776176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife