Provider Demographics
NPI:1689757940
Name:GOLYSHKO, AMY ANN (APN NP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ANN
Last Name:GOLYSHKO
Suffix:
Gender:F
Credentials:APN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N ASH STREET
Mailing Address - Street 2:
Mailing Address - City:MOMENCE
Mailing Address - State:IL
Mailing Address - Zip Code:60954
Mailing Address - Country:US
Mailing Address - Phone:815-472-4450
Mailing Address - Fax:815-937-2280
Practice Address - Street 1:500 W COURT STREET
Practice Address - Street 2:PROVENA ST MARYS HOSPITAL WOUND HEALING SERVICES
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901
Practice Address - Country:US
Practice Address - Phone:815-937-2273
Practice Address - Fax:815-937-2280
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MC1398292Medicare UPIN
ILK25793Medicare ID - Type Unspecified