Provider Demographics
NPI:1093191173
Name:PAPINEAU, AMY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PAPINEAU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:JOHANDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1120 N MELVIN ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1477
Mailing Address - Country:US
Mailing Address - Phone:217-784-2579
Mailing Address - Fax:
Practice Address - Street 1:806 E WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1584
Practice Address - Country:US
Practice Address - Phone:815-432-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012328363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400240838Medicare PIN