Basic Information
Provider Information
NPI: 1548429509
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOSE
FirstName: AMI
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: APRN, FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1614 E NORRIS DR
Address2:  
City: OTTAWA
State: IL
PostalCode: 613503681
CountryCode: US
TelephoneNumber: 8154331010
FaxNumber: 8154330067
Practice Location
Address1: 1614 E NORRIS DR
Address2:  
City: OTTAWA
State: IL
PostalCode: 613503681
CountryCode: US
TelephoneNumber: 8154331010
FaxNumber: 8154330067
Other Information
ProviderEnumerationDate: 06/05/2008
LastUpdateDate: 09/10/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X209-005149ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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