Healthcare Provider Details

I. General information

NPI: 1578074506
Provider Name (Legal Business Name): NICOLE DAWN ALMEIDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CURTIS RD
CHAMPAIGN IL
61822
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2529
US

V. Phone/Fax

Practice location:
  • Phone: 217-365-2849
  • Fax: 217-365-2850
Mailing address:
  • Phone: 217-383-6941
  • Fax: 217-383-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016178
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: