Provider Demographics
NPI:1518572536
Name:HARRIS, AMANDA COLLEEN (MSN, APRN , FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:COLLEEN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSN, APRN , FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 W FALCON CT
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-8691
Mailing Address - Country:US
Mailing Address - Phone:708-990-7018
Mailing Address - Fax:
Practice Address - Street 1:1645 W SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2157
Practice Address - Country:US
Practice Address - Phone:773-227-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily