Individual
ELLYSE SUNSHINE AMARILLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
317 SALEM PL, FAIRVIEW HEIGHTS, IL 62208-1367
(618) 277-6668
Mailing address
516 MERCER CT, O FALLON, IL 62269-3576
(217) 653-5389
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041531609
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041531609
ILLINOIS NURSE LICENSE
IL
Enumeration date
11/09/2022
Last updated
11/09/2022
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