Provider Demographics
NPI:1134671233
Name:WILHOUR, TABITHA (NP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:WILHOUR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1716
Mailing Address - Country:US
Mailing Address - Phone:217-562-2131
Mailing Address - Fax:
Practice Address - Street 1:217 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1605
Practice Address - Country:US
Practice Address - Phone:217-562-2143
Practice Address - Fax:217-562-2251
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000829363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner