Provider Demographics
NPI:1164263745
Name:HUISMAN, AMANDA N (RDH, PHDH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:HUISMAN
Suffix:
Gender:F
Credentials:RDH, PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 GENEVA LN
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6372
Mailing Address - Country:US
Mailing Address - Phone:630-903-4282
Mailing Address - Fax:
Practice Address - Street 1:2900 GENEVA LN
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6372
Practice Address - Country:US
Practice Address - Phone:630-903-4282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020015893124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist