Provider Demographics
NPI:1124766506
Name:BISKUP, AMANDA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:BISKUP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S451 WAINWRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4532
Mailing Address - Country:US
Mailing Address - Phone:630-546-0537
Mailing Address - Fax:
Practice Address - Street 1:3329 75TH STREET
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517
Practice Address - Country:US
Practice Address - Phone:630-527-3645
Practice Address - Fax:630-548-7635
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily