Healthcare Provider Details

I. General information

NPI: 1760881395
Provider Name (Legal Business Name): CHRISTINE LYN ATCHISON APN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W CHESTNUT ST
BLOOMINGTON IL
61701-2814
US

IV. Provider business mailing address

511 SHADOW LN
DECATUR IL
62526-1146
US

V. Phone/Fax

Practice location:
  • Phone: 309-557-1400
  • Fax:
Mailing address:
  • Phone: 217-840-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011698
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: