Provider Demographics
NPI:1417771692
Name:WEBER, AMANDA R (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:R
Last Name:WEBER
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6856 MIDDLEGATE LN
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-4053
Mailing Address - Country:US
Mailing Address - Phone:314-570-8866
Mailing Address - Fax:
Practice Address - Street 1:322 S BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2086
Practice Address - Country:US
Practice Address - Phone:618-967-0518
Practice Address - Fax:618-417-6049
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031040363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health