Healthcare Provider Details

I. General information

NPI: 1154724623
Provider Name (Legal Business Name): JOANITA A MAISON-BICE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANITA MAISON

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CURTIS RD
CHAMPAIGN IL
61822-9678
US

IV. Provider business mailing address

611 W PARK FAPC
CHAMPAIGN IL
61802
US

V. Phone/Fax

Practice location:
  • Phone: 217-365-6061
  • Fax:
Mailing address:
  • Phone: 217-902-6954
  • Fax: 217-902-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011959
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: