Amanda Marie Wilderman

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

209.020318 Issued in IL

Practice address

13138 Illinois 13
Coulterville, IL 62237

Phone

(618) 758-2256

NPI assigned

Oct 29, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1659915171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1268 COLE PLACE RD",
            "city": "CHESTER",
            "state": "IL",
            "postal_code": "622332054",
            "telephone_number": "618-210-7478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13138 ILLINOIS 13",
            "city": "COULTERVILLE",
            "state": "IL",
            "postal_code": "62237",
            "telephone_number": "618-758-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDERMAN",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-29",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209.020318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Chester",
            "affiliation": "N",
            "address_1": "1268 Cole Place Rd",
            "city": "Chester",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622332054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Danielle Renee Preuss, PA-C
• Brenton Rains, COTA/L
• Sparta Community Hospital D/B/a Quality Healthcare Clinics
• Evelyn Claire Sweeney, MCD, CCC-SLP
• Alexander Franklin Charles Weems

• Gerontology Nurse Practitioner in Coulterville, IL
• Providers in Coulterville, IL by specialty
• Gerontology Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.