Healthcare Provider Details

I. General information

NPI: 1245630193
Provider Name (Legal Business Name): PHOEBE MUENI MBUVI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/08/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 N PROSPECT AVE
CHAMPAIGN IL
61822-1298
US

IV. Provider business mailing address

611 W PARK ST FAPC
URBANA IL
61801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 217-337-3852
  • Fax: 217-337-3853
Mailing address:
  • Phone: 217-383-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC07630
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005097
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: