Provider Demographics
NPI:1497312672
Name:WADSWORTH, HALEIGH D (APN)
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:D
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:HALEIGH
Other - Middle Name:
Other - Last Name:NESBITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2718 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1298
Mailing Address - Country:US
Mailing Address - Phone:217-337-3852
Mailing Address - Fax:217-337-3853
Practice Address - Street 1:2718 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1298
Practice Address - Country:US
Practice Address - Phone:217-337-3852
Practice Address - Fax:217-337-3853
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019221363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner