Active NPI
Amanda Edgcomb
- Licensed Practical Nurse
- Peru, IL
National Provider Identifier
1942112263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 043090718
- Practice address
- 4461 Progress Blvd
Peru, IL 61354-1109 - Phone
- (815) 223-9678
- NPI assigned
- Sep 21, 2026
- Last updated
- Sep 21, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 043090718 | IL | Primary |
Addresses
Primary practice location
4461 Progress Blvd
Peru, IL 61354-1109
Mailing address
4461 Progress Blvd
Peru, IL 61354-1109
Phone (815) 223-9678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1789948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789948800000",
"number": "1942112263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4461 PROGRESS BLVD",
"city": "PERU",
"state": "IL",
"postal_code": "613541109",
"telephone_number": "815-223-9678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4461 PROGRESS BLVD",
"city": "PERU",
"state": "IL",
"postal_code": "613541109",
"telephone_number": "815-223-9678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDGCOMB",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-09-21",
"last_updated": "2026-09-21",
"certification_date": "2026-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "IL",
"license": "043090718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.