MRS. AMBER LYNN WENNERSTROM (NPI# 1144844572) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144844572 |
| Entity Type | Individual |
| Full Name | MRS. AMBER LYNN WENNERSTROM |
| Credential | DNP, PMHNP-C |
| Practice Address |
444 N Pleasant Ave Centralia IL 62801-3006 |
| Mailing Address |
550 Clinton St Carlyle IL 62231-1504 |
| Practice Telephone | 6184365665 |
| Mailing Telephone | 6189209057 |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2020-10-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
209021350 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | STATE BOARD OF NURSING | 209021350 | 01 |
| Street Address |
444 N PLEASANT AVE |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801-3006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356449284 | David Rugowski | Counselor | 444 N Pleasant Ave, Centralia, IL 62801-3006 | 2006-09-21 |
| 1053749432 | Darren Dunahee | Social Worker | 444 N Pleasant Ave, Centralia, IL 62801-3006 | 2013-10-23 |
| 1356629612 | Melissa Karaffa | Clinical Nurse Specialist | 444 N Pleasant Ave, Centralia, IL 62801-3006 | 2011-08-03 |
| 1285733386 | Sharon Reed | Counselor | 444 N Pleasant Ave, Centralia, IL 62801-3006 | 2006-09-22 |
| 1932208030 | Keith Johnson | Counselor | 444 N Pleasant Ave, Centralia, IL 62801-3006 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962870790 | Heather Renee Beyers | Nurse Practitioner | 1601 Medlin Rd, Centralia, IL 62801-9531 | 2015-09-10 |
| 1447222419 | Janet Rose Merrell | Nurse Practitioner | 904 M L King Dr, Centralia, IL 62801-3532 | 2006-02-03 |
| 1588085443 | Cheryl Mercurio | Nurse Practitioner | 2428 W Reynolds Ave, Centralia, WA 98531-4554 | 2013-12-19 |
| 1861758591 | Lisa B Ehrlichman | Nurse Practitioner | 2428 W Reynolds Ave, Cascade Mental Health, Centralia, WA 98531-4554 | 2012-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790384451 | Ghea Tiping Degillo | Nurse Practitioner | 4711 Golf Rd Ste 500, Skokie, IL 60076-1208 | 2020-10-22 |
| 1750989620 | Rodney J Pena Jr. | Nurse Practitioner | 1362 Trotters Ln, Bourbonnais, IL 60914-4519 | 2020-10-13 |
| 1609482231 | Crystal Lynn Jordan | Nurse Practitioner | 638 Oakbrook Ave, Chatham, IL 62629 | 2020-09-18 |
| 1497369672 | Mojisola Abayemi Akinfe | Nurse Practitioner | 8572 Stone Creek Blvd, Frankfort, IL 60423-9338 | 2020-09-03 |
| 1508475039 | Hilary Eichie | Nurse Practitioner | 20025 Division St., Crest Hill, IL 60403 | 2020-07-30 |
| 1518585942 | Tabs Behavioral Health Inc | Nurse Practitioner | 13316 Vicarage Dr, Plainfield, IL 60585-5050 | 2020-07-13 |
| 1154946788 | Latisha Trenice Stennis | Nurse Practitioner | 8106 Carol Dr, East Saint Louis, IL 62203-1838 | 2020-06-09 |
| 1114549755 | Maria Andreea Bordeianu | Nurse Practitioner | 6050 N California Ave, Chicago, IL 60659-3916 | 2020-05-16 |
| 1104448968 | Abosede Rachel Babalola | Nurse Practitioner | 2214 Monarch St, Bourbonnais, IL 60914-2780 | 2020-05-14 |
| 1659909406 | Mudira Temilola Oyewole | Nurse Practitioner | 493 Leslie Ct, Des Plaines, IL 60016-8818 | 2020-03-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.