Basham, Amanda June

Basham, Amanda June is an individual health care provider with primary practice located at 3986 Maryville Rd , Granite City IL 62040-4191. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Basham, Amanda June can be contacted via phone (618) 797-0618.

Contact Information

Primary practice address
3986 Maryville Rd Granite City IL 62040-4191
Phone: (618) 797-0618
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209025025 Illinois

Profile Details

NPI number 1780326454
LBN Legal business name Basham, Amanda June
Credentials FNP -BC
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 12th, 2022
Last updated Apr 12th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780326454 NPPES
Other 1811087604 NPI

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