Provider Demographics
NPI:1104993401
Name:BROWNLEE, AMY CARTWRIGHT (PA C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CARTWRIGHT
Last Name:BROWNLEE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 N WESTMORELAND RD
Mailing Address - Street 2:100C
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1673
Mailing Address - Country:US
Mailing Address - Phone:847-234-1177
Mailing Address - Fax:847-234-1875
Practice Address - Street 1:800 N WESTMORELAND RD
Practice Address - Street 2:SUITE 100C
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1673
Practice Address - Country:US
Practice Address - Phone:847-234-1177
Practice Address - Fax:847-234-1875
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P54824Medicare UPIN