OrganizationActive
Advantage Health Providers, Inc
NPI 1730433384 · Nurse Practitioner · Montgomery, IL
Provider details
- NPI number
- 1730433384
- Entity type
- Organization
- Primary specialty
- Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Victoria Faustino, President(630) 267-2627
- License
- 209.006796 (IL)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
2460 Hanbury Ln
Montgomery, IL 60538-5049
Phone: (630) 267-2627
Fax: (630) 503-6600
Approximate (ZIP-level) locationGet directions
Mailing address
2460 Hanbury Ln
Montgomery, IL 60538-5049
Registry dates
- Enumerated
- 2012-11-05
- Last updated
- 2012-11-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.