Provider Demographics
NPI:1609118348
Name:MANION, AMY (CPNP, PHD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MANION
Suffix:
Gender:F
Credentials:CPNP, PHD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:#123
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-642-5515
Mailing Address - Fax:312-642-0753
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:#123
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-642-5515
Practice Address - Fax:312-642-0753
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004161208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics