Healthcare Provider Details

I. General information

NPI: 1780123091
Provider Name (Legal Business Name): CHRISTIN DEMIERRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 N CONVENT ST STE 1
BOURBONNAIS IL
60914-1081
US

IV. Provider business mailing address

1615 N CONVENT ST STE 1
BOURBONNAIS IL
60914-1081
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-5200
  • Fax: 815-937-2063
Mailing address:
  • Phone: 815-937-5200
  • Fax: 815-937-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015178
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: