Provider Demographics
NPI:1871242818
Name:WYATT, COURTNEY LYNN (WHNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:WYATT
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 FRANKLIN AVE STE 2200
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6500
Mailing Address - Country:US
Mailing Address - Phone:309-888-9900
Mailing Address - Fax:309-888-9919
Practice Address - Street 1:1302 FRANKLIN AVE STE 2200
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6500
Practice Address - Country:US
Practice Address - Phone:309-888-9900
Practice Address - Fax:309-888-9919
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024925363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health