Healthcare Provider Details

I. General information

NPI: 1093118127
Provider Name (Legal Business Name): KRISTI CHIONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 EASTLAND DR
BLOOMINGTON IL
61704-7918
US

IV. Provider business mailing address

2203 EASTLAND DR
BLOOMINGTON IL
61704-7918
US

V. Phone/Fax

Practice location:
  • Phone: 800-444-6110
  • Fax:
Mailing address:
  • Phone: 800-444-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number041336362
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011877
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: