Provider Demographics
NPI:1952941833
Name:FRUEN, AMANDA J (DNP, APRN,FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:FRUEN
Suffix:
Gender:F
Credentials:DNP, APRN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 FEATHERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1944
Mailing Address - Country:US
Mailing Address - Phone:815-227-0081
Mailing Address - Fax:
Practice Address - Street 1:816 FEATHERSTONE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6300
Practice Address - Country:US
Practice Address - Phone:815-227-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235950363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner