Provider Demographics
NPI:1598330995
Name:MADENIS, AMANDA DEVELL (NHP, MW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DEVELL
Last Name:MADENIS
Suffix:
Gender:F
Credentials:NHP, MW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-5001
Mailing Address - Country:US
Mailing Address - Phone:815-566-2432
Mailing Address - Fax:
Practice Address - Street 1:5111 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-5001
Practice Address - Country:US
Practice Address - Phone:815-566-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife