Provider Demographics
NPI:1770048910
Name:HONCHELL, AMANDA K I (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:HONCHELL
Suffix:I
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARROLL
Mailing Address - State:IL
Mailing Address - Zip Code:61053-9485
Mailing Address - Country:US
Mailing Address - Phone:815-244-4489
Mailing Address - Fax:
Practice Address - Street 1:401 W MADISON ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-9485
Practice Address - Country:US
Practice Address - Phone:815-244-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018289363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology