Provider Demographics
NPI:1205485364
Name:MAURER, KAMI (FNP)
Entity type:Individual
Prefix:MRS
First Name:KAMI
Middle Name:
Last Name:MAURER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 W CEDAR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525
Mailing Address - Country:US
Mailing Address - Phone:309-219-5526
Mailing Address - Fax:
Practice Address - Street 1:IVIM HEALTH
Practice Address - Street 2:4200 REGENT ST STE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219
Practice Address - Country:US
Practice Address - Phone:877-870-1775
Practice Address - Fax:614-968-8840
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078962Medicaid