Provider Demographics
NPI:1942974431
Name:SVOB, AMY (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SVOB
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST STE 470
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-5021
Mailing Address - Country:US
Mailing Address - Phone:309-672-4908
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST STE 470
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-5021
Practice Address - Country:US
Practice Address - Phone:309-672-4908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209023265OtherLICENSE