1669782017 NPI number — GRELINDA MARIA AMANTE CRNA

Table of content: GRELINDA MARIA AMANTE CRNA (NPI 1669782017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669782017 NPI number — GRELINDA MARIA AMANTE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMANTE
Provider First Name:
GRELINDA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669782017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 BROADWAY
Provider Second Line Business Mailing Address:
BLESSING HOSPITAL ANESTHESIA
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62305-7005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-223-8400
Provider Business Mailing Address Fax Number:
217-223-9552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 BROADWAY
Provider Second Line Business Practice Location Address:
BLESSING HOSPITAL ANESTHESIA
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62305-7005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-223-8400
Provider Business Practice Location Address Fax Number:
217-223-9552
Provider Enumeration Date:
10/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  209008386 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)