Provider Demographics
NPI:1265943591
Name:QUERTERMOUS, AMY MARIE (APN-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:QUERTERMOUS
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 DR WARREN TUTTLE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2718
Mailing Address - Country:US
Mailing Address - Phone:618-253-0395
Mailing Address - Fax:618-253-0474
Practice Address - Street 1:3331 W DEYOUNG ST STE 100
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5896
Practice Address - Country:US
Practice Address - Phone:618-998-7600
Practice Address - Fax:618-997-6680
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016743208M00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily