Provider Demographics
NPI:1386324986
Name:AMANDA GWARDYS-COOK PMHNP PLLC
Entity type:Organization
Organization Name:AMANDA GWARDYS-COOK PMHNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GWARDYS-COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:217-549-2874
Mailing Address - Street 1:351 N CLOVERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-6017
Mailing Address - Country:US
Mailing Address - Phone:217-549-2874
Mailing Address - Fax:480-718-7582
Practice Address - Street 1:351 N CLOVERFIELD CIR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-6017
Practice Address - Country:US
Practice Address - Phone:217-549-2874
Practice Address - Fax:480-718-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty