Individual
MRS. AMBER LYNN WENNERSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, PMHNP-C
Contact information
Practice address
444 N PLEASANT AVE, CENTRALIA, IL 62801-3006
(618) 436-5665
Mailing address
550 CLINTON ST, CARLYLE, IL 62231-1504
(618) 920-9057
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209021350
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209021350
STATE BOARD OF NURSING
IL
Enumeration date
06/01/2020
Last updated
11/27/2023
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