Provider Demographics
NPI:1417197690
Name:TWAIT, AMANDA ANNE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANNE
Last Name:TWAIT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N HAMMES AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6680
Mailing Address - Country:US
Mailing Address - Phone:815-725-6511
Mailing Address - Fax:815-725-7166
Practice Address - Street 1:210 N HAMMES AVE
Practice Address - Street 2:STE 205
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8139
Practice Address - Country:US
Practice Address - Phone:815-972-9779
Practice Address - Fax:815-725-8144
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007495363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health