Provider Demographics
NPI:1629395868
Name:MATHEW, ANNAMMA JOHN (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNAMMA
Middle Name:JOHN
Last Name:MATHEW
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:ANNAMMA
Other - Middle Name:KOOTUMKAL
Other - Last Name:CHACKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:JHS. HOSPITAL OF COOK COUNTY, 1901 W. HARRISON STREET
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY, ADMINISTRATION BUILDING
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3714
Mailing Address - Country:US
Mailing Address - Phone:312-864-8047
Mailing Address - Fax:312-864-8014
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:JHS. HOSPITAL OF COOK COUNTY, DEPARTMENT OF PSYCHIATRY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-8047
Practice Address - Fax:312-864-8014
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007801041.251125363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health