Healthcare Provider Details

I. General information

NPI: 1730175712
Provider Name (Legal Business Name): MARCELLA A. LINDSTROM APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCELLA A HOWARD

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR
BLOOMINGTON IL
61701-3534
US

IV. Provider business mailing address

1505 EASTLAND DR
BLOOMINGTON IL
61701-3534
US

V. Phone/Fax

Practice location:
  • Phone: 309-665-4040
  • Fax: 309-664-3350
Mailing address:
  • Phone: 309-665-4040
  • Fax: 309-664-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041279589
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277000302
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: