Provider Demographics
NPI:1205162781
Name:BARUDIN, AMY GRACE (NP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:GRACE
Last Name:BARUDIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TURNER AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5007
Mailing Address - Country:US
Mailing Address - Phone:312-371-5162
Mailing Address - Fax:630-489-9621
Practice Address - Street 1:525 TURNER AVE
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5007
Practice Address - Country:US
Practice Address - Phone:312-371-5162
Practice Address - Fax:630-489-9621
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007812363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920540OtherMEDICARE PTAN (GROUP)
ILF400256916OtherMEDICARE PTAN (INDIVIDUAL)