Provider Demographics
NPI:1194458976
Name:REDMAN, ECHO AMANDA RENEE (APRN)
Entity type:Individual
Prefix:
First Name:ECHO
Middle Name:AMANDA RENEE
Last Name:REDMAN
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 1:919 N GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-1122
Mailing Address - Country:US
Mailing Address - Phone:217-433-3969
Mailing Address - Fax:
Practice Address - Street 1:1231 KLEEMANN DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2635
Practice Address - Country:US
Practice Address - Phone:217-935-5022
Practice Address - Fax:217-935-7692
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.413640163W00000X
IL209.025730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse