Provider Demographics
NPI:1578215752
Name:MALONE, AMANDA ROSE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:MALONE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ROSE
Other - Last Name:CHADDERDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1379
Mailing Address - Country:US
Mailing Address - Phone:630-933-4480
Mailing Address - Fax:630-933-6009
Practice Address - Street 1:25 N WINFIELD RD STE 201
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1379
Practice Address - Country:US
Practice Address - Phone:630-933-4480
Practice Address - Fax:630-933-6009
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.435647163W00000X
IL209.025843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse