Provider Demographics
NPI:1578942686
Name:WEED, AMANDA LYN (APN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LYN
Last Name:WEED
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
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Mailing Address - Street 1:24915 N COPPERAS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-8644
Mailing Address - Country:US
Mailing Address - Phone:309-232-5183
Mailing Address - Fax:309-664-0969
Practice Address - Street 1:2200 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4364
Practice Address - Country:US
Practice Address - Phone:309-662-3311
Practice Address - Fax:309-664-0969
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209012318364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health