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1508388372
AMBER LEE-ANN KOTH
CHAMPAIGN, IL
NPI
1508388372
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: IL 209016117)
Enumeration Date
2017-07-12
Last Update Date
2023-12-19
Business Address
AMBER LEE-ANN KOTH FNP-C
1915 S MATTIS AVE
CHAMPAIGN, IL 61821-5919
Phone number: 217-352-0516
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Mailing Address
AMBER LEE-ANN KOTH FNP-C
221 NE GLEN OAK AVE
PEORIA, IL 61636-4416
Phone number: 309-672-5500
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