Provider Demographics
NPI:1730225863
Name:GARNER, AMY RENEE (LPN)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:RENEE
Last Name:GARNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19404 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-7234
Mailing Address - Country:US
Mailing Address - Phone:217-523-0808
Mailing Address - Fax:217-523-9859
Practice Address - Street 1:320 E CARPENTER ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5185
Practice Address - Country:US
Practice Address - Phone:217-523-0808
Practice Address - Fax:217-523-9859
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse