Provider Demographics
NPI:1891233292
Name:GEILHAUSEN, AMBER MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:GEILHAUSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:KIETZMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 N CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1173
Mailing Address - Country:US
Mailing Address - Phone:618-635-2200
Mailing Address - Fax:618-635-4244
Practice Address - Street 1:325 N CALDWELL ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1421
Practice Address - Country:US
Practice Address - Phone:618-635-2221
Practice Address - Fax:618-635-2269
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily