| Doctor Name: | AMY MINER |
| NPI Number: | 1003205600 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN-CNP |
| License Number: | 209012440 |
| Business Practice Address: | 1550 Bishop Ct Mt Prospect, IL - 600566039 |
| Business Phone Number: | 8476859900 |
| Business Fax Number: | 8472949613 |
| Mailing Address: | 3616 Thayer St, EVANSTON |
| State: | IL |
| Postal Code: | 602014952 |
| Phone Number: | 8159853355 |
| Fax Number: | |
| NPI Enumeration Date: | 01/20/2015 |
| NPI Last Update Date: | 11/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209012440 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |