Provider Demographics
NPI:1902693963
Name:VICARY, AMBER MARIE (RN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:VICARY
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 SE WINDERMERE DR
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-9764
Mailing Address - Country:US
Mailing Address - Phone:309-264-3677
Mailing Address - Fax:
Practice Address - Street 1:2668 SE WINDERMERE DR
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:IL
Practice Address - Zip Code:61568-9764
Practice Address - Country:US
Practice Address - Phone:309-264-3677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041419886163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics