Healthcare Provider Details

I. General information

NPI: 1568023281
Provider Name (Legal Business Name): EMILY HENIGMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N BOWMAN AVENUE RD
DANVILLE IL
61832-2200
US

IV. Provider business mailing address

7131 E 370 NORTH RD
SIDELL IL
61876-6502
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-2955
  • Fax:
Mailing address:
  • Phone: 217-369-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141766
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: