Provider Demographics
NPI:1558813162
Name:LEFEVERS, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LEFEVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1110 CORAL DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-2205
Mailing Address - Country:US
Mailing Address - Phone:815-838-1632
Mailing Address - Fax:
Practice Address - Street 1:1110 CORAL DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-2205
Practice Address - Country:US
Practice Address - Phone:815-838-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043122846164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse