Sullivan, Wamaitha

Sullivan, Wamaitha is an individual health care provider with primary practice located at 1120 N Melvin St , Gibson City IL 60936-1477. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Sullivan, Wamaitha can be contacted via phone (217) 379-4864.

Contact Information

Primary practice address
1120 N Melvin St Gibson City IL 60936-1477
Phone: (217) 379-4864
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 277000092 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 209007740 Illinois

Profile Details

NPI number 1689908220
LBN Legal business name Sullivan, Wamaitha
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2009
Last updated Feb 23rd, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689908220 NPPES
Illinois MEDICAID 370647938007

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