Provider Demographics
NPI:1780145151
Name:BOHLAND, AMY R (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:BOHLAND
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 WAVERLY PL
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-4143
Mailing Address - Country:US
Mailing Address - Phone:815-693-9259
Mailing Address - Fax:
Practice Address - Street 1:1355 REMINGTON RD STE H
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4818
Practice Address - Country:US
Practice Address - Phone:630-701-9009
Practice Address - Fax:630-701-9010
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.421182163WG0000X
IL209.019069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice