Healthcare Provider Details

I. General information

NPI: 1609366061
Provider Name (Legal Business Name): ERIN L COLLINSWORTH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN L MILLER

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E PLUMMER BLVD
CHATHAM IL
62629-8047
US

IV. Provider business mailing address

1811 S COG MILL CT
SPRINGFIELD IL
62704-6468
US

V. Phone/Fax

Practice location:
  • Phone: 217-483-3487
  • Fax: 217-483-8150
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017628
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: