Provider Information for 1679206395
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AMANDA JANE PEARSON
Sex: Female
NPI: 1679206395
Last Updated: 2022-07-09
Certification Date: 2022-07-09
Certification Date: 2022-07-09
Details
| Name | Value | |||||||||||||||||||||
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| NPI | 1679206395 | |||||||||||||||||||||
| Enumeration Date | 2022-07-09 | |||||||||||||||||||||
| NPI Type | NPI-1 Individual | |||||||||||||||||||||
| Sole Proprietor | NO | |||||||||||||||||||||
| Status | Active | |||||||||||||||||||||
| Mailing Address | 12601 S 83RD AVE PALOS PARK, IL 60464-2024 United States Phone: 312-217-9271 | Fax: | |||||||||||||||||||||
| Primary Practice Address | 12601 S 83RD AVE PALOS PARK, IL 60464-2024 United States Phone: 312-217-9271 | Fax: | |||||||||||||||||||||
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