Provider Demographics
NPI:1669140976
Name:ALLEN, AMANDA A (APN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 NE GLEN OAK AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3112
Mailing Address - Country:US
Mailing Address - Phone:309-676-8123
Mailing Address - Fax:309-676-8455
Practice Address - Street 1:834 N SEMINARY ST STE 501
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-0501
Practice Address - Country:US
Practice Address - Phone:309-343-4114
Practice Address - Fax:309-676-8455
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209023516363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty