Provider Demographics
NPI:1396992962
Name:WATTS, JOANNE LAMANTIA (APN)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:LAMANTIA
Last Name:WATTS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 E OGDEN AVE # 2100
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1603
Mailing Address - Country:US
Mailing Address - Phone:630-548-2057
Mailing Address - Fax:
Practice Address - Street 1:1299 E OGDEN AVE # 2100
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1603
Practice Address - Country:US
Practice Address - Phone:630-548-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006920363LF0000X
IL209006920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215434007Medicare PIN
IL215435007Medicare PIN