Provider Demographics
NPI:1912546326
Name:WASSELL, CHRIS (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:WASSELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MORTON AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-4021
Mailing Address - Country:US
Mailing Address - Phone:217-588-6140
Mailing Address - Fax:217-588-3043
Practice Address - Street 1:901 W MORTON AVE STE 22
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-4021
Practice Address - Country:US
Practice Address - Phone:217-588-6140
Practice Address - Fax:217-588-3043
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041297456OtherRN