Healthcare Provider Details

I. General information

NPI: 1073147237
Provider Name (Legal Business Name): ALEXIS WERNSMAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 ML KING DRIVE, SUITE 2
CENTRALIA IL
62801-3002
US

IV. Provider business mailing address

PO BOX 25228
DECATUR IL
62525-5228
US

V. Phone/Fax

Practice location:
  • Phone: 618-436-5410
  • Fax: 618-436-8063
Mailing address:
  • Phone: 217-329-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020907
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: