Provider Demographics
NPI:1396087599
Name:KORTE, AMANDA NICHOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICHOLE
Last Name:KORTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-2547
Mailing Address - Country:US
Mailing Address - Phone:618-779-8336
Mailing Address - Fax:
Practice Address - Street 1:9423 HOLY CROSS LN
Practice Address - Street 2:SUITE 111
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3510
Practice Address - Country:US
Practice Address - Phone:618-526-8850
Practice Address - Fax:618-526-8852
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20901339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily