Provider Demographics
NPI:1871740506
Name:GOLDEN, AMY L (APN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:MONICAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-007198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1538177241 1Medicaid
ILIL2613OtherMEDICARE GROUP PTAN
ILIL2613050OtherMEDICARE INDIVIDUAL PTAN
IL0407950001Medicare NSC