Healthcare Provider Details

I. General information

NPI: 1437035516
Provider Name (Legal Business Name): CASSIE L MISCEVIC APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSIE L RODRIQUEZ

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR STE 1000
BLOOMINGTON IL
61701-7905
US

IV. Provider business mailing address

427 N WOODLAND AVE
OGLESBY IL
61348-1175
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-6270
  • Fax:
Mailing address:
  • Phone: 815-252-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209032958
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number209.032958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: