Mavis, Amanda M

Mavis, Amanda M is an individual health care provider with primary practice located at 3225 Hedley Rd , Springfield IL 62711-6248. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Mavis, Amanda M can be contacted via phone (217) 726-7300.

Contact Information

Primary practice address
3225 Hedley Rd Springfield IL 62711-6248
Phone: (217) 726-7300
Fax: (217) 726-5989
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 209016157 Illinois

Profile Details

NPI number 1396269700
LBN Legal business name Mavis, Amanda M
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2017
Last updated Jul 27th, 2017 - about 8 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 1396269700 NPPES
Illinois Other 2017014688 MHFNP CERTIFICATION

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